Hi, I'm Adrien Abrams, I'm the Chief Product Owner for the Quality Payment Program at CMS.
In this video we'll demonstrate how our new website QPP.CMS.gov allows users who represent
groups and or individual clinicians to submit to the Merit-Based Incentive Program.
If you're watching this video on YouTube you can look in the description section of the
video for a list of the topics covered and the minutes in this video in which we cover
them so that you can fast forward to the section that discusses topics that are most interesting
to you.
Before we get into the demo let's cover a little background.
The Merit-based Incentive Program data submission is comprised of three components: the Quality
component, Advancing Care Information component, and the Improvement Activities component.
In this demo we're going to show how data can be submitted in those three categories
in a few specific ways.
For the Quality component we'll show how a file, specifically a QRDA3 file, can be uploaded
to complete this category.
Additionally, we'll show what it looks like to a user representing a Group or an individual
clinician when they login and a registry has been hired to submit data on their behalf.
We'll show how Advancing Care Information can be completed by a file upload, we'll also
show the user interface that allows a user to attest to the information on the website
itself.
And for Improvement Activities we'll show how it can be completed by a file upload as
well as the attestation user interface that we've built to facilitate the task.
A complete Merit-based Incentive Program submission can be completed in one visit to our website
and or using one file in one file format.
In designing this product we've focused on providing users clear guidance on how to complete
a submission in the simplest way possible.
We've created ways for users to track their progress through the submission of Improvement
Activities and through the measures of the Advancing Care Information section.
We've also invested in the ability to score Quality measures using current benchmarks
in real time so that when a user completes a submission they get feedback on the score
and potential bonuses of those measures.
A few things this demo won't cover: the Web Interface submission process or the Submissions
API that we've created in our piloting with registries and QCDRs in the first year of
this program.
You can visit our website QPP.CMS.gov for more information on those submission mechanisms.
Additionally we've created another series of YouTube videos which specifically cover
the Web Interface submission functionality available on QPP.CMS.gov.
Let's get into the demo.
The submissions process starts with visiting QPP.CMS.gov.
On January 2nd you'll see a sign-in option in the upper right-hand side of the website.
When you click on that you'll be prompted to enter your EIDM User ID and password.
If you've previously setup an EIDM user account in support of previous CMS programs including
the Physician Value Modifier, the Quality Resource and Usage Reports, the Physician
Quality Reporting System, PQRS, and or the Web Interface used to submit Quality data
and you have a valid user role, we will have imported your user so that you'll be able
to start submitting on January 2nd, if your password hasn't expired.
If you haven't created the EIDM account previously please visit the CMS Enterprise Portal to
create an EIDM user account and request roles to represent your organization.
Your user will immediately be able to access this website after you have the correct roles
approved.
You can review the QPP EIDM user guide that's available by visiting QPP.CMS.gov in our resource
library.
For this demo we've created fake account.
I will be a Security Official so I'll have the role in EIDM of Security Official with
a group practice.
Review the statement of truth.
You must affirm that you're certifying that you're submitting data that is true accurate
and complete to the best of your knowledge.
We'll ask you to review this.
Again I'm doing this in a demo environment.
For the purpose of demo I will test yes, signing in, you'll hear a phone call.
I've set up multi-factor authentication for this account using my phone.
Hello, thank you for using our phone verification system, your code is 37362.
Once again, your code is 37362.
Goodbye.
Now I've landed on the Account Dashboard.
The Account Dashboard is constructed using a user's approved EIDM roles.
So in this case the Security Official, that I am currently, has roles with three separate
practices.
Notice that this enables me to start a submission as a group or an individual for this specific
TIN.
I could also start a submission for the next TIN and start to report as a group or for
an individual within that group here.
I'll choose to report as a group and now this menu appears.
It provides me access to the three components of the MIPS submission.
The Quality measures, the Advancing Care Information, and the Improvement Activities.
You'll also notice the left navigation it's providing the information on the TIN for which
I am starting a submission as well as another way to navigate to the three components of
the MIPS submission.
Let's start with Quality measures.
If no Quality measures have been submitted for a group or individual you'll see this
menu appear.
In this case there are two options here for this user.
For this group they can begin to start submitting Quality measures via a file upload or if this
group has hired a Registry or QCDR, EHR, or other third party vendor to compile, aggregate,
and submit their Quality measures this is the point in the process where that agency
would take over for them.
If the group had registered to use Web Interface to report Quality there'd be a third option
available for that group on this screen here.
That's not the case.
We are going to, in this demo, submit Quality data via file upload ourselves.
This file upload modal appears, it provides guidance that files can be uploaded in QPP
or QRDA3 formats.
We're going to upload in QRDA3 format because it's the format produced by EHRs.
We can drag and drop a file from our local machine here or we can browse our directory.
I've saved my QRDA3 XML file on my local desktop.
Going to open, you'll see that QRDA3 XML file, it's in a "Pending Upload" status.
We're going to upload it.
When I click upload the format of the file as well as the construction of the measures
within the file is validated.
If it's valid we'll create a submission for this TIN on QPP.CMS.gov using the data in
this QRDA3 file.
Just a note here, this file actually has Quality data, Improvement Activity data, and Advancing
Care Information data so you'll see the results of this file upload throughout the demo.
So now we have successfully completed the upload, we've created this submission.
Let's go review it by closing the modal.
Our previous menu is converted into a Quality submission summary screen.
This will be a repeated design so I'll go over a few of the design elements here.
First you'll see a link here for full instructions on how to use this page.
You'll notice that the file upload is now turned into a button on the right-hand side.
This calls the same modal we just used.
And right below that is a delete category button which would allow us to delete the
results of the upload we just performed.
The submission screen starts by defining which submission methods have been used to transmit
Quality data to QPP.CMS.gov.
A QRDA3 file uses the EHR submission method you'll see EHR here, and we've scored the
measures we've received against the benchmarks we currently have in real time and have determined
that the submission would score 60 out of the 60 possible points for the Quality category
in the submission.
Let's review how that's determined.
You have the ability to submit more than the six measures that will be used to create a
Quality category score.
We will evaluate the performance rate for each measure you submit, we'll compare them
against the benchmarks, and as well as add in the bonus points and determine which of
the measures you've submitted comprise the top six measures that would give you the greatest
score.
Additionally, we've designed this product to score all of the measures you submit so
that we provide meaningful feedback for every measure that you've invested in aggregating,
compiling, and submitting to QPP.CMS.gov.
Let's review how we score these measures.
So the first category will highlight the six measures that comprise the performance score.
Each measure submitted will create one of these horizontal bars.
In this case you'll see the measure name, the measure ID, the performance rate we received
in the file, and then the comparison of the performance rate against the benchmark, as
well as the addition of bonus points, if any are pertinent to this measure, combined into
a measure score.
To the right of the measure name there's a drop-down arrow.
When you click that you'll see the details broken out on how the measure score was determined.
On the left-hand side you'll notice the measure submitted represented as the white circle,
the national benchmark represented as the blue horizontal line, with the deciles demonstrated.
In this case this measure scored over 93% which was in the top decile.
On the right-hand side of the drop-down will convert that into points.
First, the points from the benchmark decile so this measure received the full ten out
of ten points.
There were no partial points.
Now we'll add the bonus points.
There were no high-priority outcome or patient experience bonus points associated with this
measure, no other high-priority bonus points, and this measure was eligible for an end-to-end
reporting bonus.
That means the total score for this measure was the ten for the performance points, plus
the one bonus point, equaling 11 measure points.
This level of detail is available for all of the measures here and you'll notice that
the top six measures, scored a 62.9 total points which is greater than the total 60
potential points so the max 60 points would be earned for this Quality category.
The next section will break out all measures submitted that included bonus points.
Again the same breakouts are available within these measures.
And the last category demonstrates all of the measures that were outside of the top
six or exceeded the maximum bonus points and so didn't contribute to the score.
You'll notice however that we do have the performance rates.
There is no measure score because this measure did not get attributed to the Quality category
score.
However, if you hit the drop down you'll see the comparison to the benchmark again and
the points that would have been realized if this measure was counted.
So in this case you see that there are nine points from the benchmark decile and nine
partial points no bonus points this measure would have earned 9.9 if it was considered
to be one of the top six.
One other feature I'd like to show you, let me collapse the left-hand side here a little
more room to work.
You can do that by there's a collapse button on the bottom of the left navigation menu
just gives you a little more screen room to work with.
I'm going to navigate back up to the top here.
I have an additional file so in this scenario this group has hired a QCDR to compile a series
of Quality measures for them.
I have this file from the QCDR for the purpose of this demo, I want to demonstrate what that
would look like that is a QCDR file in JSON format.
I'm uploading it, it's being validated, it's confirmed to be valid, a submission has been
created and you'll now see a new submission method added to the top here.
So previously we had EHR with a score 60 out of 60 and we just had created a registry dial
with a score of 52.3 out of 60.
If I click on this it has now turned into a button, you'll see there below the contents
are changing, and you can review the results submitted and you can see here my top six
measures scored worse than those measures that we previously reviewed via the EHR submission
mechanism.
The same breakdown is available measure by measure, the drop-down available to see performance,
how that translates into points, and we make available by category so for Quality, Advancing
Care Information, and Improvement Activities the most recent submission by each pertinent
submission method.
So you'll see here EHRs and registries, and when the submission window closes this group
would be credited with the highest score of any submission method within a category.
So in this case they'd be credited with the 60 out of 60 because it is the best Quality
score that we have received.
Let's move on now to the Advancing Care Information section.
We can expand back out our left navigation menu and go up to the Advancing Care Information
label.
The features on the Advancing Care Information page are similar to those on the Quality page.
You can read full instructions here, for how to use this page.
The file upload button is available again on the right, it pops up the same modal and
the submission methods are here again at the top of the screen.
They're not represented by dials on this, they're laid out a little differently but
you'll see the attestation button representing the submission method of completing the submission
here on the site or the EHR submission method and this tab was created when we uploaded
Advancing Care Information in our QRDA3 file earlier.
So let's complete an attestation for Advancing Care Information.
The page is currently locked down.
It's because we've designed this page to guide a user through the process of submitting Advancing
Care Information and that has to start with selecting a proper performance period.
If the user inputs an improperly constructed performance period it will prompt them that
the, for example, end date here is greater than the start date that this won't allow
us to proceed down the process of completing Advancing Care Information.
Also, if a user inputs a submission period shorter than 90 days we'll let them know that
means that they are capping their total possible points for this category at 50.
For this demo let's select a full performance, or a performance period greater than 90 days.
The next section will allow us to select the Advancing Care Information measure set that
we are going to report.
There are two that pertain, the 2017 Advancing Care Information Transition Measures and the
confusingly named Advancing Care Information Measures.
This just highlights how you determine which type of measure your EHR can submit.
It really depends the year of the certification edition that your technology received.
So in this first section if you've received the 2015 or the '14 or a combination of the
'14 and '15 you're able to report the 2017 Advancing Care Information Transition Measures.
Then here is the information for the years of the editions that can report the Advancing
Care Information Measures.
This can still be challenging to understand although we've tried to word it as simply
as possible.
So we've created a feature to allow you to look up your HER; it has autocomplete so I'll
just type in the EHR and the first that pops up is "CHARM EHR."
So for this demo let's assume that the group that I am in has CHARM EHR.
When I type that in and select it, it'll show me the additions of CHARM EHR that have been
certified.
I'll choose the most recent 2014 as mine and so now I can see that the CHARM EHR 2014 edition
is capable of reporting the 2017 Advancing Care Information Transition Measures set.
We scroll to the bottom here we'll notice that of the three buttons the 2017 Advancing
Care Information Transition Measures, the Advancing Care Information Measures, and then
the button that allows me to report a combination of both measure set, only the first the 2017
Advancing Care Information Transition Measures is selectable.
That's because of the information that we received about our EHR certification above.
If we click on this button the rest of the form will become available to start completing.
If we don't want this guidance and we want to be able to select between the three measure
sets ourselves we can uncheck the selection for EHR in that search box and now all three
buttons are selectable.
For this demo let's go through the 2017 Advancing Care Information Transition Measures.
I'll collapse my left panel again.
The first section are the required attestation statements.
The first two are mandatory and the third is actually optional so you'll see right now
I can't fill out information lower down on specific measures.
I must first complete these attestation statements.
I'm going to review the Prevention of Information Blocking Attestation.
If I concur I'm going to click "Yes" and when I do so it will turn into a green check box.
I'm going to review the second attestation, ONC Direct Review Attestation, review the
content, and click "Yes."
This now has unlocked the next section of my form.
Before we advance, let me just review the ONC-ACB Surveillance Attestation which is
optional.
I concur and I'm clicking "Yes," and now we can continue into the measures required for
a base score.
You'll see a ribbon now becomes locked at the top of my frame here which provides my
overall Advancing Care Information category score currently set at zero over one hundred
points.
It will start being completed in real time once I have completed the measures required
for base scoring section.
I can click on any of these question mark icons to get more information about how to
complete a section.
So first up is the e-Prescribing measure, it's the first of the measures required for
a base score.
I can download the measure specifications if this high level summary is not adequate.
Measure specifications are available by clicking on the blue downward arrow icon to the right
of the e-Prescribing measure name.
When I do that a PDF will be downloaded to my local browser.
I click that and open.
You'll see here a five-page PDF on the details around the e-Prescribing Transition Measure.
On the right are the numerator and denominator for this measure and then here in the bottom
is the e-Prescribing exclusion, and if I click on the icon I can see the definition for that.
If this exclusion pertains to me I can avail myself of it by clicking on the check box
and you'll notice the entire measure is greyed out which means I can move on to the next
measure without completing this one.
In this case I'm going to uncheck it and complete the numerator and denominator.
I'll get a thumbs-up which is indicating I can move on to the next section.
The Security Risk Analysis measure the detailed specification icon is available there again.
Review the content.
In this case I'm going to attest yes and I got a thumbs-up again.
I can move on to the next measure, Provide Patient Access; this is a numerator denominator
measure.
As we type in the number our site is trying to save the data to ensure that we've captured
it if we were to lose connection that would enable you to log back in and see it.
What you'll notice is that if there's a delay and typing in a numerator denominator, the
system will inform you for example that you have a numerator of 100 over a denominator
of zero in this case, which is an invalid proportion for this measure and so will not
be saved.
If I update the denominator to a valid value you'll see that the data has been saved and
captured as well as I've received the thumbs up and can move on to the next measure.
The last measure in the required for base score section is the Health Information Exchange.
So as I complete this measure you will notice that the dynamic scoring will take effect.
So we receive our thumbs up and now we both have a performance score for this measure
based on the numerator and denominator we were reported, as well as this section has
been scored and you'll see my overall Advancing Care Information category score increased
to 72 over a 100.
Just rapidly before we move on there is also an exclusion for the Health Information Exchange.
If I were to zero back out this measure this exclusion becomes available to me again.
So although I have not scored a perfect score in some of these measures required for a base
score completing the next section the optional performance measures as well as the subsequent
bonus sections can allow me to achieve the maximum 100 points in the Advancing Care Information
section.
The first measure in the optional performance section is the Immunization Registry Reporting.
Again, the same icon for downloading measure specs.
I'm going to click "Yes" and now this measure is going to be scored in real time because
we've completed the required measures for a base score.
Next measure is Patient-Specific Education, and now Secure Messaging.
Now when I complete this measure I will have achieved a maximum Advancing Care Information
score of 100 points.
This yields a green max score box down here, a 100 over 100 in my Advancing Care Information
category score, and then the category success trophy which we'll explain in a second.
This means that taking any additional action in the Advancing Care Information category
will not get me more points towards my MIPS score.
However, I'm still very capable of reporting all of the other data that I've gathered and
encouraged to do so.
The next measure is the View, Download, and Transmit measure.
Enter a numerator denominator here.
We'll see how we've performed on this measure even though the overall score has not increased.
The last measure in this category is the Medication Reconciliation which we will not report on.
This brings us to the Additional Registry Bonus section.
There are two measures in this section answering "Yes" to each of these measures yields an
additional 5% bonus.
However, if you answer "Yes" to both questions you can only receive one 5% bonus.
I'll just highlight here answering "Yes" to the Syndromic Surveillance Reporting and "Yes"
to the Specialized Registry Reporting yields 5 bonus points for the first and no additional
bonus points for the second even though I have successfully completed that activity.
The last bonus category in Advancing Care Information is the CEHRT Used measure.
If I want to receive this bonus I must do two things: on this page I must attest "Yes"
and then in the subsequent Improvement Activities section I must have completed one improvement
activity which is deemed CEHRT eligible and I'll show you how you can see that pretty
easily when we get to that section of the demo.
Going back up here we'll quickly take a look at the other submission in the Advancing Care
Information category via EHR.
You'll see it's grayed out because it was uploaded via file, it can only be updated
by a file, and you'll notice in the submission that the required attestations were not completed.
In other words this submission could not be scored, it received a zero out of a 100 points.
However, we still see the category success trophy and that's because once you receive
that in a category regardless of the submission mechanism we're just reinforcing to the user
that taking an action to change this submission will not change the maximum points that the
user is already scheduled to get for this category.
Let's continue on to the last component of your submission, the Improvement Activities.
The Improvement Activities page mimics the Advancing Care Information page we just completed.
You'll see full instructions again here.
As well as the file upload button and the same tabs that demonstrate the submission
methods by which we received Improvement Activities data for this TIN.
The attestation that we'll complete here together and then the data we received via EHR method
which was again that QRDA3 file from earlier.
Similar to the previous page we must complete the performance period before completing any
information further down.
There's no minimum 90-day reporting period and once we've selected a valid time period
the rest of the form will be unlocked.
Let's collapse this left navigation.
There are 92 Improvement Activities, so that can be a bit cumbersome to sort through.
If you know what you're looking for there is a text search field available here on the
right-hand side.
For example, I'm looking for a Medicaid specific measure.
I type in "Medicaid" in the text field and I bring up the "Engagement of new Medicaid
patients and follow-up."
In the center we have a series of filters they reference and define subcategories for
the Improvement Activities.
You'll also see filtering by weight so the total number of points that any one Improvement
Activity contributes to the overall 40 potential points and then the CEHRT eligible measures
and these are those measures that tie to the last bonus that we reviewed on that previous
Advancing Care Information submission.
So you must select one of these to receive that Advancing Care Information submission.
You'll see, you'll notice that they have an icon here, CEHRT Eligible.
Selecting one of these activities also contributes points to your Improvement Activities score.
We'll clear our filter here, so before we start selecting individual Improvement Activities
there is the Patient-Centered Medical Home Attestation which enables a group who is participating
as a Patient-Centered Medical Home to receive full credit in the Improvement Activities
section, and you'll see as soon as we check that we get our max score dialogue, our 40
out of 40 points, and our category success.
We uncheck those, see the score go back to 0 over 40.
So if we select the first three Improvement Activities, Engagement of new Medicaid patients
and follow-up that's a high giving us 20 points, Leveraging a QCDR for the use of standard
questionnaires which is a medium activity giving us 10 points, and then leveraging a
QCDR to promote the use of patient reported outcome tools, which is another medium activity,
we have now achieved our total of 40 over 40 points.
The only action you can take on the Improvement Activities page is to click "Yes" for any
of the 92 activities that have been completed and if you've clicked something improperly
just again select it again and it will uncheck.
The same as the other sections once we have achieved the category success the best score
via submission method for a category in this case Improvement Activity is what will be
used in the final submission.
So we click on the EHR tab you'll see that the EHR submitted IA data, Improvement Activity
data, only scored a 30 out of 40 points.
However, we still see the category success trophy because again the IA data submitted
via attestation received the full 40 out of 40 points.
So now we've successfully completed all three components of a MIPS submission the Quality
Measures, the Advancing Care Information, and the Improvement Activities.
You'll notice that we have not hit a "save" or "submit" button.
You're able to log out and log back in and the state of the data that you've entered,
whether you've entered all the data and achieved category success or whether you've just attested
to one measure or completed one activity will always be saved for you.
So the next time you log back in you'll return to screens that are exactly in the same state
as you leave them now.
Additionally, there's no "submit" button because we've designed this product in a way that
allows you to visit the site once or as many times as it takes to feel comfortable about
your submission.
We will take the final state of your data when the submission period closes, and that
will form your official submission.
You can revise the data as many times as you'd like, or never revise the data from the first
time you log in before the close of the submission window.
At the end of my experience I'm going to logout using the logout feature.
It's updating me here that again I can come back in and update my submissions to the end
of the submission period.
We're also providing some information that the scoring that we provide specifically on
measures is as accurate as the information that we currently have available.
There are certain aspects like benchmarking where measures that do not currently have
benchmarks will have new benchmarks created at the conclusion of the submission period.
This information will be detailed in your feedback reports that will come subsequent
to the submission period's closure.
Thanks very much for your time in reviewing this video.
You can find more information about the program as well as other useful tools on QPP.CMS.gov.
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