Succeeding in MACRA and MIPS

Samuel Peirce, User Success Specialistsamuel.peirce@elationhealth.com

1/ What MACRA means for your practice (Slides 3-10)

2/ MIPS Participation Checklist (Slides 11-13)

3/ MIPS Performance Categories (Slides 14-19)

4/ Reporting MIPS in 2017 (Slides 20-22)

5/ How Elation supports practices on MIPS (Slides 23-29)

6/ Next Steps & Q&A (Slides 30-31)

Agenda

What MACRA means for your practice

What is MACRA?

● Medicare Access & CHIP Reauthorization Act.

● Repeals the Sustainable Growth Rate.

● Replaces the Physician Fee Schedule.

● Creates the Quality Payment Program (QPP).

Why you should care about MACRA

1/ If you see Medicare patients, there is significant practice revenue at stake.

Medicare is fundamentally changing how they reimburse providers, and will begin paying for quality, not volume.

2/ The burden is on the provider to report on patient outcomes in order to capture the maximum reimbursement.

EHR vendors like Elation can help you transform your practice to consistently measure outcomes for you to report on.

3/ The MACRA Final Rule was released on October 14th 2016.

Providers have been given less than 3 months to fully prepare for MACRA, making diligence and quality information paramount to success.

4/ MACRA legislation will go into effect January 2017.

Reporting for MACRA programs will begin on January 1, 2017. Reimbursement and adjustments timing will vary depending on the MACRA program.

Why you should care about MACRA

MACRA creates 2 programs for providing quality-based payments:

How Providers get Paid under MACRA

MIPS (Default)Merit-Based Incentive Payment System

Advanced APM Advanced Alternative Payment Model

Merit-Based Incentive Payment System (MIPS)

There are currently multiple individual quality and value programs for Medicare physicians and practitioners. MACRA streamlines those programs into MIPS:

MIPS Composite Performance Score

Benefits of Participating in MIPS

● MIPS is a zero-sum game● Adjustments begin at 4%● $500 million set aside for the first 6

years for top performers● MIPS provides a single reporting

solution, replacing PQRS, MU, and VBM.● MIPS continues the industry shift

towards value

Advanced APMs have higher financial incentives, but also require increased practice transformation and reporting.

Advanced Alternative Payment Models (APMs)

Approved Advanced APM List:

CPC+ Comprehensive ESRD Care Model

MSSP ACOs - Track 2 & Track 3

Next Generation ACO ModelOncology Care Model

MIPS Participation

✓ Am I Eligible?

✓ Am I using a certified EHR technology?

✓ Do I know what the performance categories are?

✓ Do I know MIPS timeline and deadlines in 2017?

MIPS Participation Checklist

MIPS Participation Eligibility

Eligible Provider: Physician, PA, NP, CNS, and CRNA

MIPS Exclusions

1/ Less than 100 Medicare fee-for-service patients and $30,000 in Medicare charges

2/ Participating in an Advanced APM

3/ First-year Medicare providers

MIPS Performance Categories

MIPS Performance Categories

Replaces PQRS Replaces VBMNew CategoryReplaces MU

MIPS Performance Categories: 2017 Weights

Quality (60%)

Improvement Activities (15%)

Advancing Care Information (25%)

MIPS Performance Categories:Quality

Report on 6 quality measures, including at least one outcome measure

Example: CMS165v5: Controlling High Blood PressurePercentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period

Quality (60%)

MIPS Performance Categories:Advancing Care InformationReport on the 5 required measures:

1/ Security Risk Analysis

2/ e-Prescribing

3/ Provide Patient Access

4/ Send Summary of Care

5/ Request and Accept Summary of Care

Submit up to 9 measures for additional credit Advancing Care Information (25%)

MIPS Performance Categories:Clinical Improvement Activities

Report on 4 clinical improvement activities

Example: IA_BMH_4: Depression screeningDepression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan

Improvement Activities (15%)

MIPS Reporting in 2017

MIPS Reporting in 2017: Pick Your PaceMIPS

Advanced APMs

MIPS Reporting in 2017: Timeline

How Elation enables practices to achieve success with MIPS

Elation continues to be committed to supporting phenomenal care, and is committed to the Health IT requirements needed to support practices on MIPS.

Elation Supports MIPS: QualityElation’s built-in quality measures dashboard makes it easy to track your progress on quality measures

Elation Supports MIPS: QualityElation provides clinical decision support at the point of care.

Elation Supports MIPS: Advancing Care Info Elation’s built-in MU dashboard makes it easy to track your progress

Elation Supports MIPS: Advancing Care Info Elation provides MU reminders at the point of care.

Elation Supports MIPS: Improvement ActivitiesTrack diagnoses such as depression in the patient’s Problem List and Visit Note. (IA_BMH_4: Depression Screening)

Next Steps

In Summary1/ Continue providing phenomenal care to your patients

2/ Elation will continue supporting your care to ensure your success on MIPS

● Elation’s Blog: Focus on MACRA and upcoming CMS releases● Elation's MACRA Help Center

3/ Practices can start familiarizing themselves with the program

● Continue attending Elation’s webinars● Elation MIPS Guide● Quality Payment Program Website

Questions?