macra jumpstart - medical advantage group · macra jumpstart –using free cms resources for mips...

MACRA Jumpstart:Using Free CMS Resources for MIPS Success

Beth Hickerson

Lead Quality Improvement Advisor

June 21, 2017

Value Driven. Health Care. Solutions.

MACRA Jumpstart – Navigating the Quality Payment Program

2Value Driven. Health Care. Solutions.

There are many questions

surrounding MACRA, but the

bottom line is if you participate in

Medicare you will be impacted by

MACRA and the Quality Payment

Program (QPP)

MIPS or APM? Today we’ll help

you determine which track to

participate in

If you’re MIPS eligible, what is

your readiness level?

MACRA Jumpstart – Using Free CMS Resources for MIPS Success


At the close of our MACRA

Jumpstart presentation you

should have a better idea of

which track to participate in and

we will share free CMS

Resources for MIPS support

– QPP Resource Center– www.qppresourcecenter.com

– Medical Advantage Group’s

MACRA Jumpstart– www.medicaladvantagegroup.com/macra

jumpstart/

– [email protected]

http://www.qppresourcecenter.com/

http://www.medicaladvantagegroup.com/macrajumpstart/

mailto:[email protected]

Medicare Access and CHIP Reauthorization Act of 2015

(MACRA)


Repealed the Sustainable Growth

Rate (SGR) methodology

– Supported by organized medicine

– Passed with over 90 percent

support in both the House and

Senate; bi-partisan legislation

Created Quality Payment

Program which moves Medicare

into value-based payments

– Alternative Payment Model (APM)

– Merit-based Incentive Payment

System (MIPS)

Quality Payment Program (QPP)

January 1, 2017 – physicians enter the MIPS track or the APM track

For the first few years of the QPP, majority of clinicians in MIPS


Quality Payment Program

(QPP)

Merit-based Incentive

Payment System (MIPS)

Alternative Payment Model

(APM)

Advanced APM MIPS APM

ALTERNATIVE PAYMENT MODELS (APMS)

What are APMs?

Payment approach that

incentivizes clinicians to

provide high-quality, cost-

effective care

Structured models that

promote coordination and

cooperation among

providers

Full list of 2017 APMs at

https://qpp.cms.gov/docs/

QPP_Advanced_APMs_in

_2017.pdf


https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf

APM vs Advanced APM

Alternative Payment

Model

– Participation requirements

unique to each APM model

– Participants must still

report MIPS, but have a

modified scoring system

that takes their APM

activities into account

Advanced Alternative

Payment Model (AAPM)

– More stringent participation

requirements, usually

involve some level of risk

– Qualifying Participants

(QPs) are exempt from

MIPS and receive 0.5%

bonus payment

– Partial Qualifying

Participants (Partial QPs)

can opt out of MIPS without

penalty


Advanced APMs’ Eligibility Criteria

Eligibility criteria

– At least half of the clinicians must use certified electronic health

record technology (CEHRT)

– Report on quality measures comparable to MIPS quality

measures

– Be a medical home model OR require participants to bear more

than a nominal amount of financial risk

– Only medical home that

qualifies for Advanced

APM (AAPM) is CPC+


2017 Advanced APMs


MSSP Track 2 MSSP Track 3

Comprehensive

Primary Care Plus

(CPC+)

Next Generation

ACO

Comprehensive

ESRD Care Model

Oncology Care

Model-Two sided

QPs and Partial QPs for AAPMs

Qualifying Participants (QPs)

– Exempt from MIPS

– Earn an annual lump sum payment of 5 percent of the MPFS

from 2019-2024

CMS predicts that approximately 100% of eligible

clinicians in Advanced APMs will be QPs in performance

year 2017


Performance Year 2017 2018 2019 2020 20212022 and

later

Percentage of Medicare

payments through an

Advanced APM


patients through an

Advanced APM

25%

20% 35% 35% 50% 50%20%

50% 50% 75% 75%25%

QPs and Partial QPs for AAPMs

Partial Qualifying Participants (Partial QPs)

– Can opt out of MIPS without penalty

– Can report MIPS for possible incentive


Performance Year 2017 2018 2019 2020 20212022 and

later


payments through an

Advanced APM


patients through an

Advanced APM

20%

10% 25% 25% 35% 35%10%

40% 40% 50% 50%20%

Future APMs

Current Advanced APMs will reopen to allow more

participants

New models will launch:


MERIT-BASED INCENTIVE PAYMENT SYSTEM

(MIPS)

Categories and Reporting Requirements

Impact on the MPFS

Instead of a 21 percent payment cut

– No increase in MPFS (January – June 2015)

– Increase 0.5 percent (July 2015 – December 2015)

– Increase 0.5 percent per year (2016 – 2019)

– No increase (January 2020 – December 2025)

– 2026 and beyond:

– APM participants –

0.75 percent annual increase

– MIPS participants –

0.25 percent annual increase


0

0.2

0.4

0.6

0.8

201

5

201

6

201

7

201

8

201

9

202

0

202

1

202

2

202

3

202

4

202

5

202

6

202

7

MIPS Impact on Current Programs

– PQRS Quality

– VM Cost

– EHR Advancing

Care

Information

– Improvement Activities is a

new measure in MIPS


CMS legacy programs become measures in

the MIPS program

MIPS Overview

Provides both upside and

downside adjustments to the

MPFS

Maximum adjustments:

– 2019: 4 percent

– 2020: 5 percent

– 2021: 7 percent

– 2022 & beyond: 9 percent

First MIPS performance year-

2017

First MIPS payment year-2019


Threshold

4x% 5x% 7x% 9x%

-4x% -5x% -7x% -9x%

2019 2020 2021 2022

MIPS Eligible Providers

Years 1 and 2 Medicare Part

B clinicians:

Physicians MD, DO

Podiatrists

Optometrists

Chiropractors

Dentists

Physician Assistants

Nurse Practitioners

Clinical Nurse Specialists

Certified Registered Nurse

Anesthetists

Year 3+ Medicare Part B

clinicians:

Occupational Therapists

Physical Therapists

Speech Therapists

Audiologists

Nurse Midwives

Clinical Social Workers

Dietitians


Who is Exempt from MIPS?

3 groups of clinicians:


First year of

Medicare Part B

participation

Below low patient

volume threshold

Qualified

Participants in

ADVANCED

Alternative

Payment Models100 or fewer Part B patients

OR billing no more than

$30k/year

NOTE: MIPS does not apply to hospitals or facilities

MIPS Category Measures Over Time

A score of 0-100 developed for each eligible clinician based

on performance in four categories:


Quality

Advancing Care

Information

Improvement

Activities Cost

Replaces PQRS Replaces MU New (PCMH) Replaces VBM

2017 60% 25% 15% 0%

2018 50% 25% 15% 10%

2019+ 30% 25% 15% 30%

Three MIPS Options to Participate in 2017

To avoid a negative adjustment in 2019, submit to CMS

one of the following in 2017:


1Quality

Measure

1Improvement

Activity

5Required Advancing Care

Information

Measures

OR OR

Reporting

Individual – defined as a single NPI tied to a single TIN

– CEHR

– Registry

– Qualified clinical data registry

Group – must share a common TIN

– CEHR

– Registry

– Qualified clinical data registry

– CMS web interface – must register by June 30, 2017


Quality – 60%

Select 6 measures to

report on from about

300 quality measures

Or select from a set of

specialty specific

measures

Full list of measures at

https://qpp.cms.gov/m

easures/quality


Must report for

at least 90 days

to be eligible for

a positive

adjustment

3-10 points per

measure based

on performance

against a

benchmark

60 possible

points

Bonus points for

high-priority and

EHR reporting

60Points

https://qpp.cms.gov/measures/quality

Advancing Care Information – 25%


Choose between 2 lists of Advancing Care Information

(ACI) Objectives ad Measures

ACI Objectives and Measures 2017 ACI Transition Objectives and

Measures

5 required base measures 4 required base measures

9 optional performance measures 7 optional performance measures

2015 Certified EHR 2014 Certified EHR

Stage 3 Meaningful Use standards Modified Stage 2 Meaningful Use

standards

Advancing Care Information Performance Category Fact Sheet available at

https://qpp.cms.gov/resources/education


Advancing Care Information – 25%


– Security risk analysis

– e-Prescribing

– Provide patient access

– Health Information

Exchange

– 5 percent for public

health/clinical data

registry reporting

– 10 percent for

improvement activity

alignment

– Provide patient access

– Health information

exchange

– View, Download, or

Transmit

– Patient-specific education

– Secure messaging

– Medication Reconciliation

– Immunization Registry

reporting

Required base

score*

Optional performance

score*

Bonus score

50 90 15

*2017 ACI Transition Objectives and Measures

Improvement Activities – 15%

Attest to completing activities

that improve clinical practice

for at least 90 days during the

year

92 activities in 9 categories

Accumulate 40 points for

maximum category scoring

– Medium-weighted activities

(10 points)

– High-weighted activities (20

points)

Points are doubled for small,

rural, and health professional

shortage area practices


1. Expanded

Practice

Access

2. Population

Management

3. Care

Coordination

4. Beneficiary

Engagement

5. Patient

Safety and

Practice

Assessment

6. Participation

in an APM

7. Achieving

Health Equity

8. Integrating

Behavioral and

Mental Health

9. Emergency

Preparedness

and Response

Improvement Activities – 15%

Full credit for clinicians in CPC+, in a PCMH, or in

similar specialist practice

– PCMH certifications for MIPS include: a national program,

a regional or state program, a private payer, or other body

that certifies at least 500 practices

Partial or full credit for participation in an APM

Full list of Improvement Activities, with details on action

required and suggested documentation, available at

https://qpp.cms.gov/resources/education under MIPS

Data Validation Criteria



Cost – 0%

Clinicians are not required to submit cost data to CMS

– CMS assesses clinicians based on Medicare claims data

CMS compares resources used to treat similar care

episodes and clinical condition groups across practices

Cost measures adjusted for geographic payment rates

and beneficiary risk factors

ECs earn a maximum of 10 points per episode cost

measure


MERIT-BASED INCENTIVE PAYMENT SYSTEM

(MIPS)

Scoring and Payment Adjustments

Pick Your Pace Options

Three options to participate in MIPS in 2017:


Don’t submit

Pick Your Pace Options

Four options to participate in MIPS in 2017:


No

Participation

Minimum

Participation

Partial

Participation

Full

Participation

• Report

nothing

• -4% penalty

• Report

1 Quality measure

Or

1 Improvement

Activity

Or

4/5 Required

Advancing Care

Information

measures

• 0% adjustment

• Report more

than minimum

for at least 90

days

• Small incentive

• Report all

categories for at

least 90 days

(preferably one

full year)

• Up to 4%

incentive

• Possible bonus if

≥ 70 points

Scoring Basics

Each provider/practice will receive a final score for

each MIPS category based on performance

Category scores will be calculated (based on category

weighting) to produce a total score between 1-100


Payment Adjustment Basics

CMS will publish a “performance threshold” score at

the start of each year

Each Eligible Clinician’s (EC’s) final score is compared

to the performance threshold score

ECs with a score exactly at threshold will receive no

MIPS adjustment

ECs with a score below threshold will receive a

negative payment adjustment

ECs with a score above threshold will receive a

positive payment adjustment factor

Adjustment percentages are variable based on EC

score compared to threshold score


2017 Final Scores and Adjustments


Final Score Payment Adjustment

≥70 points – Positive adjustment

– Eligible for exceptional performance bonus – minimum of

additional 0.5%

4-69 points – Positive adjustment

– Not eligible for exceptional performance bonus

3 points – Neutral payment adjustment

0 points – Negative payment adjustment of -4%

– 0 points = does not participate

35

Budget Neutrality

>> Amounts accrued from penalties assessed

against ECs with scores below the threshold will fund

payments for ECs with scores above the threshold


Additional Incentive Payments and Support

For 2019-2024, maximum of $500 million per year in

additional incentive payments may be available to

distribute to ECs who have “exceptional performance”

– Final score of 70 or higher qualifies for an additional payment in

2017 (2019 payment year)

– Not budget neutral

Technical support for small and rural practices

– QPP Small, Underserved, and Rural

Support (QPP SURS)


Example of MIPS Negative Adjustment


MPFS

Reimbursement

2017 data/

2019 payment

2018 data/

2020 payment

2019 data/ 2021

payment

2020 data/

2022 payment

Maximum Loss 4% 5% 7% 9%

$50,000 $2,000 $2,500 $3,500 $4,500

$100,000 $4,000 $5,000 $7,000 $9,000

$400,000 $16,000 $20,000 $28,000 $36,000

Example of MIPS Positive Adjustment

38

MPFS

Reimbursement

2017 data/

2019 payment

2018 data/

2020 payment

2019 data/

2021 payment

2020 data/

2022 payment

Plus or Minus 4% 5% 7% 9%

Bonus 10% 10% 10% 10% 10%

$50,000 $7,000 $7,500 $8,500 $9,500

$100,000 $14,000 $15,000 $17,000 $19,000

$400,000 $56,000 $60,000 $68,000 $76,000


Physician Compare Website

Shows MIPS composite

scores and individual

performance category

scores

Patients can see health

care providers rated on a

scale of 0 to 100 and

how physician compares

to peers nationally


PREPARING FOR MIPS 2017

Based on your practice’s capabilities

Pick Your Pace - Minimum and Ideal

Good - Submit data on at least one quality measure,

one improvement activity or four advancing care

information transition measures to avoid a 4% negative

adjustment

Better - Submit more than the required data in 1 or

more categories for least 90 days to possibly earn a

modest positive adjustment

Best - Submit full data in all 3 categories for at least 90

days (one full year preferred) to possibly earn the

maximum positive adjustment


If you previously reported PQRS

1. Review the list of 2017 Quality measures to verify that

your previous measures are still available

➢ https://qpp.cms.gov/measures/quality

➢Measures Group reporting is no longer an option!

2. If reporting Quality via Claims, continue adding the

appropriate codes to Medicare claims

3. If reporting Quality via EHR or registry,

➢ review your quality measure reports for accuracy, and

contact your vendor if there are obvious issues

4. Begin improving performance on quality measures


https://qpp.cms.gov/measures/quality

If you previously reported Meaningful Use

1. Review the list of 2017 ACI Transition Objectives and

Measures

➢ https://qpp.cms.gov/measures/aci

2. Print your 2017 Year-to-Date ACI or MU report

3. Verify that you are able to meet all required base

measures (especially the Health Information Exchange

measure)

4. Begin improving on your optional performance

measures


https://qpp.cms.gov/measures/aci

If you do have an EHR & have not reported

1. Choose an improvement activity that you can complete

for 90 days, and begin implementation

➢Review the list at https://qpp.cms.gov/measures/ia

2. Contact your EHR vendor for guidance on MIPS

reporting

➢Do you need a software upgrade?

➢How do you review Quality and ACI reports?

➢How much is MIPS reporting per provider?


https://qpp.cms.gov/measures/ia

If you do not have EHR & have not reported

1. Choose an improvement activity that you can complete

for 90 days, and begin implementation

➢Review the list at https://qpp.cms.gov/measures/ia

2. Begin learning how to submit quality information via

claims

➢Contact your billing company to see if they can assist

➢ Begin educating yourself at

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

Assessment-

Instruments/PQRS/Downloads/2016PQRS_Claims_Codin

gRpgPrinc.pdf

3. Begin exploring EHR options


https://qpp.cms.gov/measures/ia

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/Downloads/2016PQRS_Claims_CodingRpgPrinc.pdf

TYING IT ALL TOGETHER

Start Working on QPP Activities now

Next Steps – Using Free CMS Resources for MIPS Success


Determine your eligibility – MIPS or

APM

If you’re MIPS eligible, and your

practice is under 15 physicians, rural,

or underserved, you likely qualify for

FREE support through the QPP

Resource Center

How to Sign Up: visit the

www.qppresourcecenter.com – click

the “Join Now” button at the top,

answer a few short questions about

your practice and you’re on your way!

Questions: Contact Us - 800.264.7221

or [email protected]

http://www.qppresourcecenter.com/

mailto:[email protected]

Next Webinar – July 21


Visit Medical Advantage Group’s

MACRA Jumpstart Page:

– www.medicaladvantagegroup.com/mac

rajumpstart/

Register for our July 21 webinar:

– MACRA Jumpstart: Preparing Your

Small Practice for MIPS Success

http://www.medicaladvantagegroup.com/macrajumpstart/

Beth [email protected]


macra jumpstart - medical advantage group · macra jumpstart –using free cms resources for mips...

Documents