Medicare Access & CHIP Reauthorization Act of 2015 (MACRA ... · What is MACRA? •Proposed rule...

transcript

Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Part II

Alex Goulding

Agenda

• Overview

• Path 1: MIPS

• Path 2: Eligible APMs

• Additional resources

OVERVIEW

What is MACRA?

• Proposed rule targeted for spring 2016

• Final rule targeted for fall 2016

• Permanently repeals SGR

• Changes the way Medicare rewards clinicians for value over volume

• Two paths– #1: Streamlines existing quality reporting

programs into one system under MIPS

– #2: Provides bonus payments for participation in eligible APMs

MACRA goals

Offer multiple pathways with varying levels of risk and rewards to tie more payments to value

Expand opportunities for a broad range of providers to participate in APMs

Minimize reporting burdens for APMs

Promote understanding of each clinician’s status with respect to MIPS/APMs

Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage and other payer arrangements

Medicare fee-for-service

30%Medicare payments are tied to quality or value through APMs by the end of 2016, and 50% by the end of 2018

Goal 1:85%

Medicare fee-for-service payments are tied to quality or value by the end of 2016, and 90% by the end of 2018

Goal 2:

Timeline

Source: CMS.gov (https://goo.gl/54ON3Y)

PATH 1: MIPS

Path 1: Merit-based Incentive Payment System (MIPS)

Physician Quality

Reporting Program (PQRS)

Meaningful use (MU)

Value-based Modifier (VBM)

Physician Quality

Reporting Program (PQRS)

Meaningful use (MU)

Value-based Modifier (VBM)

MIPS performance categories

Quality Measures Resource Use Clinical Practice Improvement Activities Meaningful Use

MIPS – clinical practice improvement activities

Expanded Practice Access

Same day appointments for

urgent needs

After hours clinician advice

Population Management

Monitoring health conditions &

providing timely intervention

Participation in a qualified clinical data

registry

Care Coordination

Timely communication of

test results

Timely exchange of clinical information with patients AND

providers

Use of remote monitoring

Use of telehealth

Beneficiary Engagement

Establishing care plans for complex

patients

Beneficiary self-management assessment &

training

Employee shared decision making

Patient Safety Practice

Assessment

Use of clinical checklists

Use of surgical checklists

Assessments related to maintaining of

certification

Alternative Payment Models

Participation in an APM will also count

for CPIA

MIPS payment adjustment

Source: CMS.gov (https://goo.gl/54ON3Y)

MIPS eligible professionals (EPs):

2019 & 2020 (First two

years)

• Physicians

• Physician Assistants

• Certified Registered Nurse Anesthetists

• Nurse Practitioners

• Clinical Nurse Specialists

• Groups that include such professionals

• Secretary can add EPs described in 1848(k)(3)(B) to MIPS

Excluded from MIPS:

*MIPS does not apply to hospitals or facilities

More on MIPS

• CMS is expected to:

– Offer timely (such as quarterly) confidential feedback reports to each MIPS EP starting July 1, 2017

– Provide information about items and services furnished to the EPs patients by other providers and suppliers for which payment is made under Medicare to each MIPS EP, beginning July 1, 2018

– Make information about the performance of MIPS EPs available on Physician Compare

PATH 2: ELIGIBLE APMS

Path 2: Eligible alternative payment models (APMs)

• Encourages expansion of APM options, especially specialists

• Qualifying participants:– Are not subject to MIPS – which means you will

not be subject to MU!

– Receive bonus payments

Qualifying participants

APM participants

APMs according to MACRA

APMs include:

CMS Innovation Center model

Demonstration:

a) under the Health Care Quality Demonstration Program

or b) required by Federal Law

Sample of expected eligible APMs

Physician Focused Payment Models (PFPMs)

PFPM process

Submission of model proposals

Technical Advisory Committee review proposals, submit recommendations to

HHS Secretary

Secretary comments on CMS website, CMS considers

proposed model

How will MACRA affect me?

Source: https://goo.gl/okDAPb

Potential rewards

MIPS only

• MIPS adjustments

Partial APMs

• APM-specific rewards

• MIPS adjustments*

Eligible APMs

• APM-specific rewards

• 5% lump sum bonus

*The legislation is currently written such that these EPs will be subject to MIPS adjustments. This could change to optional in the final rule.

ADDITIONAL RESOURCES

Additional resources

MACRA Pathway infographichttp://goo.gl/NjicIb

MACRA Fact Sheethttp://goo.gl/D5Mc0A

CMS.gov MIPS & APMshttps://goo.gl/bhf8v5

Acronyms

• CMS: Centers for Medicare & Medicaid Services• HHS: U.S. Department of Health & Human Services• MU: Meaningful Use• EP: Eligible Professional• MACRA: Medicare Access and CHIP Reauthorization Act of 2015• SGR: Sustainable Growth Rate• MIPS: Merit-based Incentive Payment System• PQRS: Physician Quality Reporting System• VBM: Value-based Modifier or Value-based Payment Modifier• APM: Alternative Payment Model• QP: Qualifying Participant• CPIA: Clinical Practice Improvement Activities• MSSP: Medicare Shared Savings Program• CMMI: Center for Medicare & Medicaid Innovation• ACO: Accountable Care Organization• PCMH: Patient Centered Medical Home• PFPM: Physician Focused Payment Model

Contact information

• alex.goulding@greenwayhealth.com

• @AlexJGoulding

Twitter

• https://www.linkedin.com/in/ajgoulding

THANK YOU!

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