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An Introduction to MACRA’s Quality Payment Program and its Impact on Medicare Part B Reimbursement August 4, 2016 MACRA 101
An Introduction to MACRA’s Quality Payment Program and its Impact on Medicare Part B
Reimbursement
August 4, 2016
MACRA 101
• MACRA Proposed Rule Overview– Merit-based Incentive Payment Program (MIPS)
– Advanced Alternative Payment Models
• Timeline
• Eligibility
• Reporting
• How to Prepare
• Q&A
Outline
Elizabeth Arend,
MPH, Quality
Improvement
Advisor, National
Council for
Behavioral Health
Speakers
Frank Winter, Partnership
Manager, Centers for
Medicare & Medicaid
Services
Nina Marshall, MSW
Senior Director, Policy
and Practice
Improvement,
National Council for
Behavioral Health
MACRA: From Volume to Value
90% of Medicare fee-for-service payments will be tied to quality or value by 2018
Clinicians can choose either:
• The Merit-Based Incentive
Payment System (MIPS),
which streamlines multiple
quality programs
• An Advanced Alternative
Payment Model (APM),
which provides bonus
payments for participation
Two Paths to Payment:
MACRA’s New Quality Payment Program
Medicare Part B clinicians including:
• Physicians (including psychiatrists)
• Physician assistants
• Nurse practitioners
• Clinical nurse specialists
• Certified registered nurse anesthetists
Who will MACRA’s Quality Payment
Program (QPP) impact?
• Clinical psychologists and licensed clinical social workers
• First-year Medicare providers
• Qualifying Advanced APM clinicians
• Hospitals and facilities
• Providers who serve fewer than 100 Medicare recipients and bill Medicare less than $10,000 per year (“low-volume threshold”)
• Clinicians and groups who are not paid under the Physician Fee Schedule (i.e. FQHCs and partial hospitalization programs)
In 2017, the QPP will NOT apply to…
• MACRA is scheduled to go into effect on
January 1, 2017.
• CMS will use reporting in 2017 to determine
payment adjustments in 2019.
Implementation Timeline
The Merit-Based Incentive
Payment Program
(MIPS)
• MIPS consolidates three existing quality
incentive payment programs
– Physician Quality Reporting System
(PQRS)
– Electronic Health Records Incentive
Program (“Meaningful Use”)
– Value-based Payment Modifier (VBM)
• Adds “Clinical Quality Improvement Activity”
category
What is MIPS?
Performance Categories and
Scoring
• CMS will factor in four weighted performance categories to create eligible clinicians’ MIPS Composite Performance Score (CPS)
• Category weights may be redistributed depending on eligible clinicians’ reporting capabilities
• Performance category weights are expected to change over time
QUALITY(50%)
RESOURCE USE
(10%)
ADVANCING CARE
INFORMATION(25%)
CLINICAL PRACTICE
IMPROVEMENT ACTIVITIES
(15%)
CPS(0-100)
PQRS Value
ModifierMeaningful
Use
MIPS Payment Adjustments
Anticipated MIPS Payment Adjustments
Clinician Category % Expected to Receive Positive Adjustment
% Expected to Receive Negative Adjustment
All eligible clinicians (ECs)
54% 46%
ECs in practices with 100+ clinicians
81% 11%
ECs in practices with 25-99 clinicians
45% 55%
ECs in practices with 2-9 clinicians
30% 70%
ECs in solo practices 13% 87%
Advanced Alternative
Payment Models
(APMs)
Alternative Payment Models (APMs)
• Participants must use certified electronic
health record technology
• Advanced APMs must carry more than
nominal financial risk OR be a medical home
model expanded under CMMI authority
…therefore NOT an option for most behavioral
health care providers
Advanced APMs
Timeline & Payment Adjustments
Final rule expected November 1, 2016
Remember…
Register Today!
www.TheNationalCouncil.org/events-and-training/webinars
• August 11th: The Merit-
Based Incentive Payment
System (MIPS) Survival
Guide
• August 16th: PQRS &
MIPS in the Real World:
Three Organizations Share
their Experiences
Coming Up Next…
Questions
Thank you!
Elizabeth Arend, MPH
Quality Improvement Advisor
National Council for Behavioral Health
