MACRA and the

Health Information Technology Community

The Medicare Access and CHIP Reauthorization Act of 2015

Establishing new ways to pay physicians for caring for Medicare

beneficiaries

Presented by: Liz Hansen, CMUP, CHSP, CHSA, PCMH CCE

Interoperability Grant Program Manager, SCHIExSenior Advisor, GA-HITEC

Executive Board, GA-HIMSS

AgendaMACRA

Overview of MACRA

Comparison with MU Stage III

Recommendations for preparation and

success

Create an X-Factor in understanding

MACRA

What is MACRA?

• Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)– Children’s Health Insurance Payment System (CHIP)– Bipartisan legislation – Signed into law on April 16, 2015– 962 pages

• Public commentary through June 27, 2016

• Final regulations published October 14, 2016– 2,398 pages

• Comment period through December 17, 2016

MACRA

• MACRA is part of a broader push towards value and quality

• In January 2015, the Department of Health and Human Services announced new goals for value-based payments and advanced payment models (APMs) in Medicare

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

Why MACRA?MACRA

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

Why MACRA?MACRA

What is MACRA?

• Quality Payment Program

• Establishes new ways to pay physicians for caring for Medicare beneficiaries

• Path to value

MACRA

What is MACRA?

• Repeals the Sustainable Growth Rate (SGR) Formula• Changes the way that Medicare rewards clinicians for

value over volume• Streamlines multiple programs under the new Merit-

Based Incentive Payments System (MIPS)• Provides bonus payments for participation in eligible

alternative payment modes (APMS)

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-

Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

MACRA

MACRAMACRA moves us closer to meeting these goals and

toward transforming our healthcare system

What is MACRA?

What is MACRA?

Two Tracks of MACRA

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-

Programs/MACRA-MIPS-and-APMs/MACRA-LAN-PPT.pdf

The Merit-

based

Incentive

Payment

System (MIPS)

or

Advanced

Alternative

Payment

Models

(APMs)

MACRA

MIPS

There are currently multiple individual quality and value programs for Medicare physicians and practitioners:

MACRA

Physician Quality

Reporting

Program (PQRS)

Value-Based

Payment Modifier

Medicare EHR

Incentive Program

MACRA streamlines these programs into one

Merit-Based Incentive Payment System(MIPS)

QualityImprovement

Activities

Advancing Care

InformationCost

The MIPS composite performance score will factor in performance

in 4 weighted performance categories on a 1-100 point scale

MIPS: Four Categories

60

%15

%

25

%0%

Begins in 2018

MACRA

The potential

maximum

adjustment % will

increase each

year from 2019 to

2022

MIPs payment adjustments are required to be budget neutral.

This means that rather than additional spending, higher reimbursement for those

who score well will come from reduced payments to those with poorer performance.

MIPS Payment StructureMACRA

.

Flexibility

• 2017 designated transition year– Impacts payments for 2019

• CMS envisions 2018 transitional to ramp-up and performance thresholds

• Anticipates new proposals on parameters

• On-going changes

MACRA

.

MACRA

Flexibility Announcment

Option 1 - Any data reported will allow providers to avoid a

negative payment adjustment.

Option 2 - Allows providers to submit data for a reduced number of

days. This means their first performance period could begin later

than Jan. 1 and that practice could still qualify for a small payment

if it submits data on how the practice is using technology and how

it's improving.

Option 3 - The third option is for practices that are ready to go in

2017.

Option 4 - Participate in an advanced alternative payment model

such as a Medicare Shared Savings ACO.

MACRA

QualityImprovement

Activities

Advancing Care

InformationCost

The MIPS composite performance score will factor in performance

in 4 weighted performance categories on a 1-100 point scale

MIPS: Four Categories

60

%15

%

25

%0%

Begins in 2018

MACRA

MIPS: Advancing Care Information Performance Category

Advancing Care

Information

Replaces the

Medicare EHR

Incentive Program

Meaningful Use

25%In 2017, there are two measure set options for

reporting:

Option 1: Advancing Care Information Objectives and Measures (15 measures)

Option 2: 2017 Advancing Care Information Transition Objectives and Measures (11 measures)

Choose to submit up to 9 measures for a minimum of 90 days for additional credit.

For Bonus Credit: Report Public Health and Clinical Data Registry Reporting measures

** May not need to submit advancing care information if measures do not apply.

MACRA

Advancing Care

Information

Replaces the

Medicare EHR

Incentive Program

Meaningful Use

Security Risk Analysis e-Prescribing Provide Patient Access Send Summary of Care Request/Accept Summary of Care

25% 2017 Required Measures

Reporting on all five of these would achieve 50%

Fulfill the required measures for a minimum for 90 days

MIPS: Advancing Care Information Performance CategoryMACRA

MACRA sunsets the Medicare Electronic Health Record (EHR) Incentive Program - Meaningful Use

Enables reporting either for individual clinicians or for a group of clinicians

Allows for additional data submission methods beyond attestation, such as registry and EHR methods, previously reserved only for PQRS reporting

Requires that clinicians agree implement CEHRT in good faith such that no inhibition of health information exchange nor information blocking occurs

MIPS eligible clinicians who were previously ineligible for MU will not be accountable for the ACI category

MIPS does not impact the Medicaid Meaningful Use (MU) nor eligible hospital MU programs

MIPS: Advancing Care Information

.

http://www.saignite.com/MU-to-ACI

MACRA

MIPS: Advancing Care Information Performance Category

Advancing Care Information

1.Security Risk Analysis

2.Electronic Prescribing

3.Provide Patient Access

4.Send Summary of Care

5.Request/Accept Summary of Care

Meaningful Use Stage 3

1.Protect Patient Health Information

2.Coordination of Care

3.Patient Electronic Access to Health

Information

4.Quality of Care

5.Health Information Exchange

6.Interoperability

7.Public Health and Clinical Data

Registry Reporting

Crosswalk: ACI vs MUMACRA

20

MU

100% score required on all measures to avoid

5% penalty

Included redundant measures and

problematic CPOE, CDS and clinical quality

measures

QPP / ACI

Pass-fail program replaced with base and

performance scoring

Measures reduced

Performance score thresholds eliminated

Public health registry reporting reduced

Concerns

50 point base score threshold still 100%; security attestation

required

Remaining MU measures unchanged; simply

reorganized

MU exclusions eliminated

Limited TA/Outreach

Not yet Defined

MIPS / ACI vs Meaningful UseMACRA

APM: Alternative Payment Model (the other MACRA option)

Qualified APM providers qualify for a 5% bonus (no penalty!) in 2019:

– Use certified EHR technology,

– Payment is based on quality measures comparable to the MIPS Quality performance category

– Bear more than “nominal financial risk,” or the APM is PCMH Ø At least 25% of payments and 20% of patients under an approved advanced APM

• Advanced APM is not just any APM - must be CMS approved

If not MIPS, then…MACRA

CMS-approved APM Models

Qualified Advanced Payment Models:

• Comprehensive ESRD Care Model • Medicare Shared Savings Program – Track 2 • Medicare Shared Savings Program – Track 3 • Comprehensive Primary Care Plus (CPC+) • Next Generation ACO Model • Oncology Care Model (Two-sided Risk

Arrangement)

MACRA

Entities that participate in Qualified Advanced APM models (Example: CPC+) but have LESS THAN the required % of revenue or patients at risk

• Revenue and Patient at risk requirements for this category

• To qualify for the “hybrid” option in 2019, Clinicians and groups must have:

– REVENUE: At least 20% but not more than 25% of Medicare payments tied to APM

– Patients: At least 10% but not more than 20% of patients tied to APM

– (Note: Thresholds increase in 2021 and 2023)

• Result if you qualify for the “hybrid” option?

– No MIPS reporting requirements. But no 5% APM bonus in 2019

– No payment adjustments (either plus or minus)

Option 3: Partially Qualifying APM ParticipantsMACRA

CMS is driving APM over MIPS

• APM? Bonus (or neutral) only

• MIPS? Bonus (or neutral) AND Penalty

• Manage risk or manage penalties?

• Overall goal? Shift more and more financial risk to the providers through APM and not MIPS-like reporting

APM vs MIPS MACRA

The potential

maximum

adjustment % will

increase each

year from 2019 to

2022

MIPs payment adjustments are required to be budget neutral.

This means that rather than additional spending, higher reimbursement for those

who score well will come from reduced payments to those with poorer performance.

MACRA Why Should You Care?

.

MACRA Why Should You Care?

The Medicare Access and CHIP Reauthorization Act (MACRA)--which replaced the much-maligned Sustainable Growth Rate formula--represents the most profound change to physician compensation in the United States in more than 25 years. There's going to be a lot of anger and frustration."

President Steven Stack, M.D.President, American Medical Association

.

MACRA Why Should You Care?

• Ripple effect throughout our industry• Pharma and Medical Device foresee negative impact• CIO’s anticipate burden, expecting requests for

assistance• Commercial Executives expect increased revenues• Providers anticipating decreased revenues, barriers

and struggle• HIT will be needed for almost every aspect of MACRA

Your knowledge of MACRA could provide you

with the X-Factor

.

1. Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.)

2. Initiate Community of Care / Community of Practice meetings3. Use professional society resources4. Review and analyze MU and Quality reports5. Patient Engagement Playbook6. Participate in TCPI and/or PCMH7. Determine which track is best for the practice8. Determine risk9. Technical Assistance for ACI10.Allocation of $20 million/year from 2016-2020 to small

practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM

11.Begin preparation now!

MACRA How Can You Prepare?Increase Your X-Factor

.

How Can You Prepare?Increase Your X-Factor

1. MACRA expert in your organization2. Participate in available webinars (National, local, HIMSS, RECs,

HIEs, etc.)3. Provide webinars for your clients or prospects4. Start a Community of Practice (web-based)5. Provide a MACRA checklist and/or flyer for your clients or

prospects6. How does your product or service impact MACRA or vice versa? 7. Use professional society resources8. Patient Engagement Playbook9. Research TCPI or PCMH10.Begin preparation now!

MACRA

.

Key Take-Away

Points

1. The Quality Payment Program changes the way Medicare pays clinicians and offers financial incentives for providing high value care.

2. MACRA makes the provider environment MORE competitive

3. This will be a heavy lift for most providers

4. Contains components consistent with MU Stage 3

5. Payment adjustments and bonuses will begin in 2019

6. Begin preparation now!

Focus on lessening the burden of keeping score and increase the focus on providing increased patient care.

MACRA

.

MACRA

• Centers for Medicare and Medicaid Services

– https://qpp.cms.gov/measures/performance

– http://go.cms.gov/QualityPaymentProgram

– www.cms.gov/ehrincentiveprograms

• South Carolina Health Information Network

– www.SCHIEx.org

• SC Quality Improvement Organizations (QIOs)

• SC Transforming Clinical Practice Initiative (TCPI) Practice Transformation Networks (PTNs)

– https://innovation.cms.gov/initiatives/Transforming-Clinical-Practices/

ResourcesMACRA

Thank You! Contact Info:

Liz Hansen, CMUP, CHSP,

CHSA, PCMH CCE

lmhansen@health-eit.com

Questions / DiscussionMACRA