Meaningful Use

MACRA

MIPS/APM

May 2016

• 960+ regulations

• Our understanding

• May not have everything correctly

• Stayed tuned, more webinars

Disclaimer

Public Comment

• Nothing changes in 2016 (maybe 90 days)

• PQRS, VBM, MU

• Comments accepted July 27,2016

• Final rule doesn’t usually change significantly

• Final rule not likely before 4th quarter 2016

• Proposed starting date January 1, 2017, payment adjustment

is 2 years later

• CMS Budget neutral

• Priority, BCBS and others are adopting similar programs

MACRA PROPOSED Rule

• Relates to Medicare Part B FFS

• RHC/FQHC ? (believe included)

• MACRA begins 2017

• 2017 Performance

• 2019 Payment adjustments

• 2017 Activity/2019 payment adjustments

• MIPS: +/- 4% Medicare FFS,

• +12% for “exceptional performance”

• APS: + 5% Medicare FFS

MACRA Financial Implications

JC

MACRA – Financial Summary

JC

MACRA Strategy

• Focusing on improving the way clinicians are paid to

incentivize quality and value of care over simply quantity of

services;

• Improving the way care is delivered by providing clinical

practice support, data and feedback reports to guide

improvement and better decision-making; and

• Making data more available and enabling the use of certified

EHR technology to support care delivery.

MACRA Strategy

JC

4 Main Terms

• MACRA: Medicare Access and CHIP Reauthorization Act

of 2015

• QPP: Quality Payment Program

• MIPS: Merit based Incentive Payment System

• APM: Advanced Alternative Payment Models

JC

Advanced Alternative Payment Models (APM)

Advanced APMs meet certain criteria

JC

APM, What is it?

JC

APM’s Criteria

JC

APM, How do I become Qualified

JC

APM, Medical Home Models

JC

MACRA: MIPS

Change from MU to MACRA/MIPS

MIPS – Payment Adjustment/Incentive

Outstanding Performance:

additional 3 times upper limit,

approximately top 10% of

country

Who Qualifies (MIPS)

• MU was only concerned about MD, DO, NP (some PA)

• MIPS

• Year 1:MD, DO, DMD, DDS, NP, PA, Clinical Nurse Specialist

and Certified Registered Nurse Anesthetists.

• Year 3+: add physical/occupational therapist, speech language

pathologist, audiologist, Nurse midwives, clinical social workers,

clinical psychologist, dietitians/nutrition professionals

• Medicare billing (Part B) under their own name.

Who Does NOT Qualifies (MIPS)

Current Medicare at Risk

-9%

-2%

+/-4%

-3%

Proposed Medicare at Risk

MIPS % in 2017/2019 Similar to Requires

Quality 50% PQRS Report on 6 measures

Resource Use

(Cost)

10% Cost CMS calculation from

claims data

Clinical Practice

Improvement

Activities

15% PCMH PCMH certification or

specific practice

activities

Advancing Care

Information

25% MU Eliminates all or nothing

threshold values *

MACRA/MIPS Composite Score

MIPS – Weight Changes Over Time

MIPS Composite Score

MIPS

MIPS - Quality

MIPS - Quality

• 50% of your score (will change over time)

• PQRS and VBM

• Compare yourself against the rest of providers

• Select those measures that count

• 9 (PQRS/VBM) in 2016

• 6 in 2017+ • Check what is certified for your EHR

Quality

• 9 measures, 2016 PQRS

• 6 measures, 2017+, MIPS

MIPS, ACI (old Meaningful Use)

MIPS ACI (it’s all about the score)

100 points maximum

MIPS, ACI, Base

MIPS, API, Base Score

• Base Score: 50 points • Base Score involves reporting the numerator (of at least one) and denominator for 6

objectives comprising 11 measures

• To receive the base score, clinicians must provide the numerator/denominator or yes/no for

each objective and measure. Only "yes" responses count

• No thresholds for the base score

• No more CPOE or Clinical Decision Support

• Security Risk Assessment (all or nothing), mitigation plan

Number Objective Measure

1. Protect Patient Health Information Security Risk Analysis

2. Electronic Prescribing ePrescribing

3. Patient Electronic Access a. Patient Access

b. Patient-Specific Education

4. Coordination of Care Through Patient Engagement a. View, Download or Transmit (VDT)

b. Secure Messaging

c. Patient-Generated Health Data

5. Health Information Exchange a. Patient Care Record Exchange

b. Request/Accept Patient Care Record

c. Clinical Information Reconciliation

6. Public Health and Clinical Data Registry Reporting Immunization Registry Reporting

(Optional) Syndromic Surveillance Reporting

(Optional) Electronic Case Reporting

(Optional) Electronic Case Reporting

(Optional) Public Health Registry Reporting

MIPS, API, Performance

MIPS, ACI, Performance Score

MIPS, ACI, Performance

• Performance Score: 80 points (50 points is all you

need)

• Based on 8 measures with 10% per measure

• Providers select the 8 measures that are best for

them, must report on all 8.

MIPS

MIPS – Clinical Improvement Process

JC

MIPS – Clinical Improvement Process

MIPS

MIPS - Cost

MIPS Summary

• 2016

• Monitor and improve MU performance %

• Identify and improve practice appropriate PQRS measures

• Evaluate ACO and PCMH opportunities

• Design Clinical Improvement Activities

• CEHRT upgrade strategy

• 2017

• Select MIPS or APM

• Monitor MU (ACI) performance

• Monitor and improve Quality Metrics

• Implement Clinical Improvement Activities

• Upgrade CEHRT to 2015 (MU 3) version

Recommended Strategies

JC

• 2016 and 2017

• Current CEHRT acceptable

• 2015 CERHT might be preferable

• ~=MU 3

• 2018

• 2015 CEHRT required

• ~=MU 3

Certified EHR Upgrade

Questions

Randi Terry: rterry@mhc.net

Joe Cook, DO: Jcook1@mhc.net

MACRA Payment at Risk

• MACRA will eventually account for 10% of the

payment of the Medicare bill (expect to grow in the

future)

• Medicare ONLY (Priority, BCBS, etc. have similar

programs)

• Fee for service: 100% based on service

• Fee for service – 10% (not new money).

MACRA Big Picture

• Nothing changes for 2016 (maybe 90 days)

• MACRA/MIPS/APR Proposed Rule. Final in September

• Rule deals with “at risk payment” (value verses volume)

• All practices need a strategy for 2017 and beyond

• ~9% of Medicare fees

• Only applies to Medicare EP’s (not Medicaid)

• Payment adjustment 2 years later

• Budget Neutral

Proposed Medicare at Risk

(MU)

MACRA MIPS 2017/2019

2016/2018 MACRA Transition

• Proposed Rule

• MACRA strategy

• Financial

• MACRA/MIPS

• MACRA/APS

• Medicaid MU Incentive $

• CEHRT

• Recommended Strategies

MACRA Overview

Composite Score

• MIPS: 100 point scale known as Composite Performance

Score (CPS), 2017 performance/2019 payment

• Quality: 50 percent of total score

• Resource Use: 10 percent of total score

• Clinical Practice Improvement Activities (CPIA): 15 percent of total

score

• Advancing Care Information (formerly Meaningful Use): 25 percent

of total score