Quality Payment ProgramThe Quality Payment Program:Implications for Diabetes ManagementPatricia A. Meier, M.D.Chief Medical Officer, CMSKansas City Regional OfficeNovember 17, 20161

Quality Payment ProgramWhat is “MACRA”?MACRA stands for the Medicare Access and CHIP Reauthorization Act of2015, bipartisan legislation signed into law on April 16, 2015.What does it do? Repeals the Sustainable Growth Rate (SGR) Formula Streamlines multiple quality reporting programs into 1 newsystem (MIPS) Provides bonus payments for participation in advancedalternative payment models (APMs)2

Quality Payment ProgramThe Quality Payment ProgramThe Quality Payment Program policy will: Reform Medicare Part B payments for more than 600,000 clinicians Improve care across the entire health care delivery systemClinicians have two tracks to choose from:The Merit-based IncentivePayment System (MIPS)If you decide to participate in traditionalMedicare, you may earn a performance-basedpayment adjustment through MIPS.ORAdvanced Alternate Payment Models(APMs)If you decide to take part in an Advanced APM, youmay earn a Medicare incentive payment forparticipating in an innovative payment model.5

Quality Payment ProgramHow Are MIPS Performance Categories Weighted?Weights assigned to each category based on a 1 to 100 point scaleTransition Year Weights— 25%QualityImprovementActivitiesAdvancingCare InformationCost60%15%25%0%NOTE: These are defaults weights; the weights can adjust incertain circumstances4

Quality Payment ProgramMIPS Performance Category:Quality Category Requirements-Replaces PQRS and Quality Portion of the Value Modifier-“So what?”—Provides for an easier transition due to familiaritySelect 6 of about 300 quality measures(minimum of 90 days to be eligible formaximum payment adjustment); 1 must be:Mayofalso60%finalselectscorespecialty-specific setof measures Outcome measure OR High-priority measure—defined asoutcome measure, appropriate usemeasure, patient experience, patientsafety, efficiency measures, or carecoordinationDifferent requirementsfor groups reportingCMS Web Interface orthose in MIPS-APMsMay also selectspecialty-specific setof measures5

Quality Payment ProgramMIPS Performance Category: ImprovementActivities Clinicians choose from about 90 activities under 9 subcategories:1.Expanded Practice Access2.Population Management3.Care Coordination4.Beneficiary Engagement5.Patient Safety and Practice Assessment6.Participation in an APM7.Achieving Health Equity8.Integrating Behavioral and Mental Health9.Emergency Preparedness and Response6

Quality Payment ProgramWebsite walk-through:

Quality Payment ProgramQuality Measures: Diabetes Search8

Quality Payment ProgramQuality Measures: Diabetes Eye Exam9

Quality Payment ProgramQuality Measures: Diabetes Foot Exam10

Quality Payment ProgramQuality Measures: HbA1c Control11

Quality Payment ProgramClinical Improvement: Diabetes Search12

Quality Payment ProgramImprovement Activities: Diabetes Search13

Quality Payment ProgramImprovement Activities: Diabetes Search14

Quality Payment ProgramImprovement Activities: Diabetes Search15

Quality Payment ProgramMedicare Diabetes Prevention Program

Quality Payment ProgramProposed Medicare Diabetes PreventionProgram Benefit DescriptionCDC-approvedDPP curriculum12 monthCore Benefit Minimum of 16core sessionsFirst 6 months MonthlymaintenancesessionsSecond 6 monthsMaintenanceSessionsAFTER 1st YEAR: monthlymaintenance sessions IFpatient achieves & maintainsminimum weight loss17

Quality Payment ProgramProposed Beneficiary Eligibility Must meet Body Mass Index (BMI) Criteria:– 25 ( 23 for Asian beneficiaries) Must have Blood Test Results:Have within the 12 months prior to the first core session:– Hemoglobin A1c of 5.7-6.4%; or– Fasting plasma glucose of 110-125 mg/dL; or– Two-hour plasma glucose of 140–199 mg/dL No previous diagnosis of diabetes (gestational diabetes isallowable) or End-Stage Renal Disease (ESRD).18

Quality Payment ProgramMDPP Conference Call: November 3019

Quality Payment ProgramContact InfoPatricia A. Meier, M.D.Chief Medical OfficerCMS Kansas City Regional [email protected]