What You Need to Know

The Centers for Medicare and Medicaid (CMS) announced sweeping adjustments for healthcare professionals and organizations participating in Medicare quality reporting programs in an effort to provide relief to those fighting the 2019 Novel Coronavirus (COVID-19) pandemic.

On March 22nd, 2020, CMS announced exceptions and exemptions related to reporting requirements as well as upcoming measure reporting. Clicking on one of the three categories below will bring you directly to the summary of the relief efforts aimed at that particular type of program.

 

Provider Programs

The programs impacted by the CMS announcement are:

  • Quality Payment Program – Merit-based Incentive Payment System (MIPS)
  • Medicare Shared Savings Program Accountable Care Organizations (ACOs)

With regards to the 2019 Data Submission, the deadlines have been extended from March 31st, 2020, to April 30th, 2020. Specific to MIPS, “eligible clinicians who have not submitted any MIPS data by April 30th, 2020, will qualify for the automatic extreme and uncontrollable circumstances policy and will receive a neutral payment adjustment for the 2021 MIPS payment year” (CMS.gov).

 

Hospital Programs

The programs impacted by the CMS announcement are:

  • Ambulatory Surgical Center Quality Reporting Program
  • CrownWeb National ESRD Patient Registry and Quality Measure Reporting System
  • End-Stage Renal Disease (ESRD) Quality Incentive Program
  • Hospital-Acquired Condition Reduction Program
  • Hospital Inpatient Quality Reporting Program
  • Hospital Outpatient Quality Reporting Program
  • Hospital Readmissions Reduction Program
  • Hospital Value-Based Purchasing Program
  • Inpatient Psychiatric Facility Quality Reporting Program
  • PPS-Exempt Cancer Hospital Quality Reporting Program
  • Promoting Interoperability Program for Eligible Hospitals and Critical Access Hospitals

With regards to the 2019 Data Submission, submission of Q4 (October 1st, 2019, through December 31st, 2019) data, is now optional. If Q4 data is submitted, it will be used to calculate 2019 performance and payment, where applicable. If no Q4 data is submitted, 2019 performance will be calculated using data from Q1 through Q3 (January 1st, 2019, through September 30th, 2019).

With regards to the 2020 Data Submission, CMS will not count data from Q1 (January 1st, 2020, through March 31st, 2020) or Q2 (April 1st, 2020, through June 30th, 2020). No data needs to be submitted to CMS for either Q1 or Q2 of 2020.

Specific to the Hospital-Acquired Condition Reduction Program and the Hospital Value-Based Purchasing Program, “if data from January 1, 2020 – March 31, 2020 (Q1) is submitted, it will be used for scoring in the program (where appropriate)” (CMS.gov)

 

Post-Acute Care (PAC) Programs

The programs impacted by the CMS announcement are:

  • Home Health Quality Reporting Program
  • Hospice Quality Reporting Program
  • Inpatient Rehabilitation Facility Quality Reporting Program
  • Long Term Care Hospital Quality Reporting Program
  • Skilled Nursing Facility Quality Reporting Program
  • Skilled Nursing Facility Value-Based Purchasing Program

With regards to the 2019 Data Submission, submission of Q4 (October 1st, 2019, through December 31st, 2019) data, is now optional. If Q4 data is submitted, it will be used to calculate 2019 performance and payment, where applicable. If no Q4 data is submitted, 2019 performance will be calculated using data from Q1 through Q3, (January 1st, 2019, through September 30th, 2019).

With regards to the 2020 Data Submission, data from Q1 (January 1st, 2020, through March 31st, 2020) or Q2 (April 1st, 2020, through June 30th, 2020) does not need to be submitted to CMS to be in compliance with quality program report requirements.

Specific to the Home Health and Hospice Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey, “data from January 1st, 2020, through September 30th, 2020, (Q1-Q3) does not need to be submitted to CMS.” (CMS.gov)

Specific to the Skilled Nursing Facility (SNF) Value-Based Purchasing Program, “qualifying claims will be excluded from the claims-based SNF 30-Day All-Cause Readmission Measure (SNFRM; NQF #2510) calculation for Q1-Q2.” (CMS.gov)

 

If you have specific questions related to recent CMS activities, Innovista Health Solutions strongly encourages you to visit CMS’s “Current Emergencies” page on the CMS website. To visit this page and access the resources stored there, click here.

Link: CMS Announces Relief for Clinicians, Providers, Hospitals and Facilities Participating in Quality Reporting Programs in Response to COVID-19

 

 

About Innovista

Innovista Health Solutions is a population health management company that offers management and support services to guide independent physician networks, medical groups, and health systems through the ever-changing landscape of value-based care. With services and toolsets including network development, population health management, delegated services, data reporting, and strategic capital investments, Innovista is structured to help its clients succeed in their Commercial, Medicare, and Medicaid value programs. Innovista is a single resource for physician integrated models to gain access to innovative technology, expert programs, actionable data insights, financial resources, and growth opportunities, to navigate and succeed in value-based and/or risk-based contracts.

 

Innovista Media Contact

Laura Bingham

lbingham@innovista-health.com