MACRA

Medicare Access and CHIP Reauthorization Act

MACRA

THREE MAJOR CHANGESEnding the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.

Making a new framework for rewarding health care providers for giving better care not just more care.

Combining the existing quality reporting programs into one new system.

1

2

3

These changes create the:

QUALITY PAYMENT PROGRAM

TWO TRACKS FOR PHYSICIANS TO CHOOSE FOR REPORTING

MIPSMerit-based Incentive System APMs

AlternativePaymentModels

MIPS

MIPS is a new program which combines the Physician Quality Reporting System, Value Modifier and Meaningful Use programs into one program.

MU PQRS VM MIPS

MIPS

Physicians receive a composite score based on their performance in these 4 areas:

MIPS

= MIPS Composite Performance Score

Quality Resource

Use

Clinical Practice

Improvement Activities

Meaningful EHRUse

+ + +

COMPOSITE PERFORMANCE SCORE BREAKDOWN:

Your Composite Performance

Score will determine if you

receive a negative

adjustment, no adjustment or a

positive adjustment to your funding.

APMs

APMs

APMs provide a new way for Medicare to compensate healthcare providers.

Most providers who participate in APMs will also be subject to MIPS.

Advanced APMs are not subject to MIPS.

Advanced APMs include:

• Accountable Care Organizations (ACOs)

• Patient Centered Medical Homes

• Bundled Payment Models

Very few health systems will fall into this category at first.

AdvancedAPMs

Almost everyone reports under MIPS in 2017

Whether you are taking the MIPS or APM track the majority will report for MIPS.

Exclusions:• New to Medicare• Very low Medicare billing volume• Qualified for advanced APM status

REPORTING OPTIONS

Option 1

Testthe Quality Reporting Program

Option 1

Submit some data to the Quality Payment Program, including data from after January 1, 2017.“ “

Yup…it’s that vague. (Look for more information when the final rule is released.)

Option 1

If completed,you’ll avoid anegative adjustment.

Participate for part of the calendar year

Option 2

Option 2

Submit MIPS information for a reduced number of days.

• You can start later than January 1, 2017• Select from the list of quality measures and

improvement activities in MIPS

Option 2

If completed, you could still qualify for a small positive payment adjustment.

Option 3

Participate for the fullcalendar year

Option 3

Submit MIPS information for a full calendar year.

• First performance period begins January 1, 2017

Option 3

If completed, you could qualify for a “modest positive payment adjustment.”

Option 4 Option 4

Participate in an Advanced Alternative Payment Model in 2017

Option 4

If you receive enough of your Medicare payments or see enough of your Medicare patients through the Advanced Alternative

Payment Model in 2017, then you can

report with this option.

Option 4

If completed, you could qualify for a +5% incentive payment in 2019.

To learn more about Medisolv’s Quality Reporting software that

supports your needs visit Medisolv.com

www.medisolv.com | (844) 633-4675 | info@medisolv.com