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Oncology market access conference aligning quality incentives
- 1. Aligning Quality Incentives in Oncology Care between Industry and Providers Kevin W. Mayo, Ph.D., E.DJ
- 2. Our Nation’s Evolution Toward Value Based Reimbursement and Alternative Payment Models SGR MACRA QPP 2015 1997 2017 New Performance Category Existing Precursor Program Quality Physician Quality Reporting System (PQRS Cost Value Based Payment Modifier Program Improvement Activity Not applicable Advancing Care Information Meaningful Use Program Volume Value The Quality Payment Program is a Refinement of Precursor Programs
- 3. QPP incentives Alternative Payment Models but allows providers to participate in a modified FFS system Merit Based Payment System Alternative Payment Models
- 4. How is a MIPS Score Calculated? Providers are assessed on Four Categories Percentage in 2017 Quality Advancing Care Information Improvement Activity Cost Catergory 2019 2020 2021 Quality 60% 50% 30% Cost 0% 10% 30% Improvement Activity 15% 15% 15% Advancing Care Information 25% 25% 25% MIPS Composite Performance Scores are calculated by assigning a score to each of four weighted categories
- 5. Participating in ASCO’s Oncology Care Model can qualify you as an Advanced APM or change how MIPS is reported 4 Radiation Subspecialty Measures 19 General Oncology Measures Providers or groups are assessed on their performance of Quality Measures that are included in the final MIPS quality measures list – must report on 50% of patients for at least six Quality Measures including one outcomes measure In 2016 physicians were able to meet their PQRS requirements using ASCO’s Quality Oncology Practice Initiative (QOPI) platform. In 2017, practices will be able to use QOPI to meet the MIPS reporting of one measure which is the minimum requirement to avoid a 2019 penalty
- 6. What are the potential implications for the Life Sciences Industry? Promote use of processes and tools that engage patients for adherence Promote use of Patient-Reported Outcomes (PRO) tools Promote use of Shared Decision Making tools 1) CMS is encouraging the use of Qualified Clinical Data Registry (QCDR) reporting mechanisms which pull directly from EHRs. Many of the QCDR metrics will allow industry to align with and even support provider quality initiatives 2) CMS will include the cost of Part B drugs in its assessment of cost performance. Initially Part D drug costs will be excluded but could be added in future years. Costs will be attributed to physicians at the individual level. Physician scores will be made publicly available. 3) The evolution toward Advanced Alternative Payment Models could eliminate solo/small practices and witness group practices being acquired by hospitals, ACOs or other entities.