The MACRA Transition: Understanding the Rule & Maximizing Your Success

Industry WebinarJanuary

Housekeeping

● Webinar Recording and Presentation Slides

● Questions for Panelists

Panelist

Ryan Spikes, RN BSN, CHTS-PW/IM, PCMH CCE, CHSP

Chief ConsultantMiripa Consulting, LLC

rspikes@miripa.com

QPP Program Objectives➢ The Strategic Objectives include the following: ➢ 1. Improve beneficiary outcomes and engage patients through

patient-centered Advanced APM and Merit-based Incentive Payment System (MIPS) policies.

➢ 2. Enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools.

➢ 3. Increase the availability and adoption of robust Advanced APMs. ➢ 4. Promote program understanding and maximize participation through

customized communication, education, outreach, and support that meets the needs of the diversity of physician practices and patients, especially the unique needs of small practices.

➢ 5. Improve data and information sharing to provide accurate, timely, and actionable feedback to clinicians and other stakeholders.

➢ 6. Ensure operational excellence in program implementation and ongoing development.

Eligible Clinician➢ Provider Types:➢ Physicians ➢ Physician Assistants ➢ Nurse Practitioners ➢ Clinical Nurse Specialists ➢ Certified Registered Nurse Anesthetists

➢ Providers that BOTH➢ Bill more than $30,000 annually➢ AND see more than 100 patients per year

➢ Exempt if➢ Newly enrolled in Medicare in 2017 (does not apply to changing practices)➢ Low Volume Threshold that meet either of the inclusions above➢ May volunteer to participate (no incentives or adjustments)

➢ Significantly Participating in APMs

➢ One Track of Quality Payment Program➢ Expected to include <20% of Clinicians in 2017 but increase over

years

➢ Payment approach that gives added incentive payments to provide high-quality and cost-efficient care➢ Can apply to a specific clinical condition, a care episode, or a

population

➢ MACRA does not change how any particular APM rewards value.

➢ Only some of these APMs will be eligible APMs

➢ Most physicians and practitioners who participate in APMs will be subject to MIPS and will receive favorable scoring under the MIPS clinical practice improvement activities performance category

Alternative Payment Models

➢ Formerly known as “qualifying APM Participants” (QPs)➢ Advanced APMs are a subset of APMs

➢ let practices earn more for taking on some risk related to their patients' outcomes

➢ Use certified EHR technology

➢ Earn the 5% lump sum bonus in 2019 for Advanced APM participation in 2017 if:➢ You receive 25% of your Medicare Part B payments through an Advanced

APM ➢ See 20% of your Medicare patients through an Advanced APM➢ You'll need to send in the quality data required by your Advanced APM

(Respective Website)

➢ Are not subject to MIPS ➢ Receive 5% lump sum bonus payments for years 2019-2024 ➢ Receive a higher fee schedule update for 2026 and onward

Advanced Alternative Payment Models

Advanced Alternative Payment Models

➢ Other track of Quality Payment Program (QPP)

➢ Requires 2014 or 2015 certified Electronic Health Record

➢ Can use registries to extract and submit data

Merit Based Incentive Payment System (MIPS)

Payment Adjustments

➢ Individual – unique NPI and EIN

➢ Across all 4 categories

➢ Submit via EHR, Registry, or Qualified Clinical Data Registry

➢ Quality data can be reported via Medicare claims

➢ Group - 2 or more NPIs reassigned to 1 EIN

➢ APM

➢ One payment adjustment

➢ Optional-may still participate as Individual

➢ Submit via CMS Web Interface, EHR, Registry, or Qualified Clinical Data Registry

➢ Must Register as group by June 30 to use CMS Web Interface

Group vs. Individual Reporting

Submission Methods

Pick your Pace

➢ “Submit Something”

➢ Submit minimum data Medicare➢ 1 quality measure OR

➢ 1 improvement activity OR

➢ 4/5 required Advancing Care (Include SRA)

➢ Avoid negative adjustment (Neutral)➢ If no participation, Automatic 4% negative payment

adjustment

Pick your pace- TEST

➢ At least 90-days of 2017 data➢ Must start collecting data by Oct 2, 2017

➢ Best choice if not ready to collect data yet

➢ Neutral or Small Adjustment➢ Can earn full 4% positive payment adjustment

Pick your pace- PARTIAL

➢ Best way to get maximum positive adjustment➢ The more your participate = higher potential incentives

➢ Positive payment adjustments are based on performance not time

➢ Most measures to choose from

➢ Best preparation for future years

➢ Submit 365 days of 2017 data➢ Deadline March 31, 2018

➢ Submit info from all Categories

Pick your pace- FULL

MIPS Categories

➢ 60% of 2017 Final Score➢ Replaces PQRS ➢ Choose 6 from >270 Measures based on applicability to specialty➢ Use tool at https://qpp.cms.gov/measures/quality for estimation➢ Can Run eCQMs to report

➢ Test-➢ Submit 1 Measure

➢ Partial and Full➢ At least 6 measures with 1 outcome and 1 high-priority for at least

90-days➢ Group➢ Using Web Interface-Report 15 measures for full year➢ APMs- Report per APM guidelines

QUALITYQuality

➢ 0% of 2017 Final Score

➢ Replaces Value Based Modifier

➢ “To provide actionable information that is useful to clinicians and, together with the other components of the MIPS program, drive lowered costs and improved patient outcomes”

➢ Nothing to submit in any year➢ Reporting will be calculated from adjudicated claims

➢ Data will be pulled in 2017, but not weighted in final score.

Cost

➢ 15% of 2017 Final Score➢ Choose from >90 activities under 9 subcategories➢ Recognized PCMH and APMs automatically get full

credit➢ Test

➢ 1 activity for 90-days

➢ Partial and Full➢ 1 of the combos

➢ Group of <15 or Rural➢ 2 activities for 90-days

➢ Certified PCMH or APM ➢ Full Credit

Improvement Activities

➢ Formally Meaningful Use➢ 25% of Final Score in 2017

➢ Max of 155% capped at 100% to allow flexibility

➢ Report on measures for 90+ days➢ Required Base: Security Risk Analysis, eRx, Patient Electronic Access,

Send/Accept Summary of Care

➢ Performance: Submit up to 4 optional measures

➢ Bonus Credit

➢ Report Public Health or Clinical Data registry➢ Use EHR to complete certain improvement activities

➢ May exclude measures that don’t apply

➢ Must choose applicable measures first

Advancing Care Information

➢ MIPS eligible clinicians can report the ACI objectives and measures if they have➢ Technology certified to the 2015 Edition

➢ A combination of technologies from the 2014 and 2015 Editions that support these measures In 2017

➢ MIPS eligible clinicians can alternatively report the 2017 ACI transition objectives and measures if they have➢ Technology certified to the 2015 Edition

➢ Technology certified to the 2014 Edition

➢ A combination of technologies certified to the 2014 and 2015 Editions

Advancing Care Information Reporting

➢ Automatic 0% reweight for Optional reporting➢ Insufficient Internet Connectivity, Extreme Uncontrollable

Circumstances, Lack of Control of CHERT Availability➢ Hospital-based MIPS➢ No Face-Face Interactions➢ Provider types➢ NPs➢ PA➢ CRNA➢ CNS

➢ 25% goes to Quality Performance Category

ACI- FlexibilityACI Flexibility

➢ 60% of Final Score

➢ Failure to submit = 0 points

➢ 3-10 points on quality when measured against benchmarks (Depends on number so submissions)➢ No Benchmark = 3 points

➢ Bonus Points➢ Submitting an additional high-priority measure (1-2pts)➢ Using CEHRT to submit measures to registries or CMS

(1pt)

➢ Max 100%➢ *Maximum number of points = # of required measures x

10

Scoring – Quality

➢ Assess through claims data

➢ Will be pulled for 2017, but weighted 0%

➢ Feedback will be given to clinicians

Scoring - Cost

➢ Total of 40 pts

➢ 15% of Final Score

➢ Activity Weights➢ Medium 10 pts

➢ High 20 pts

➢ APM or PCMH automatically get full points

Scoring – Improvement Activities

➢ Base Score➢ Must fulfill required measures at least to prove capability (Numerator of 1) ➢ Up to 50%

➢ Performance Score➢ Determined by performance rate for each measure with numerator and

denominator (1% for every 10 points)➢ Immunization Registry Yes =10 points➢ Up to 90%

➢ Bonus➢ 5% or PH registry➢ 10% for using CHERT ➢ Up to 15%

➢ Total 155% capped at 100% then multiplied by 25% to give contribution to MIPS score

➢ https://qpp.cms.gov/docs/QPP_ACI_Fact_Sheet.pdf

Scoring – Advancing Care Information

➢ The final score is also available for public reporting➢ Physician Compare Support Team ➢ PhysicianCompare@Westat.com

Final score

➢ Adjustment is determined by CMS algorithm based on➢ How may participants

➢ How well the participants do

➢ >70 MIPS final score = minimum +0.5 % payment adjustment

➢ Submit data by March 31, 2018

➢ Adjustments begin Jan 2019➢ Up to ±4%

➢ Increase to ±9%

How Final Score Translates to Payment

Technical Assistance

➢ Contact the Quality Payment Program Service Center➢ qpp@cms.hhs.gov➢ 1-866-288-8292.

➢ *Quality Payment Program Website: QPP.CMS.GOV➢ Advanced APM Learning Networks➢ Georgia- Aliant Quality GMCF-http://gmcf.allianthealth.org/➢ *https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Asse

ssment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html

➢ MIRIPA Consulting ➢ www.miripa.com➢ 1-866-835-1981

Resources

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