Post on 24-May-2020
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MACRA – MIPS vs. APMs for Ortho Fracture Surgeons
Alexandra Page, M.D.Chair, AAOS Health Care Systems Committee
Let the fun begin!
DISCLOSURES
My disclosures are listed on the AAOS Website.
I have no conflicts relevant to this presentation
Payment Reform 2017 - MACRAnyms:
1. MACRA: Medicare Access and CHIP Reauthorization Act of 2015
2. QPP: Quality Payment Program◦ MIPS: Merit-based Incentive Payment
System ACI: Advancing Care Information
◦ APMs: Alternative Payment Models◦ A-APMs: Advanced APMs
3. CJR: Comprehensive Care for Joint Replacement
4. EPM: Episode Payment Model◦ SHFFT: Surgical Hip/Femur Fracture Treatment
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MIPS vs. APM
90%+ will need to report via MIPS (Merit-based Incentive Payment System)
Currently (2017) APM options limited, particularly for specialists
Reimbursement (and ease of reporting) strongly favor APMs, hence need to stay aware of the opportunity
Should be more options available by 2018 (CJR, SHFFT, new “advanced” BPCI)
“Pick your Pace” in MIPS
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https://qpp.cms.gov/measures/quality
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https://qpp.cms.gov/
AAOS Performance Measures Committee
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(Clinical Practice) Improvement Activity – 15%
40 Points: ◦ 2 high-weighted (20 pts) Activities
◦ 4 medium-weighted (10 pts) Activities
◦ Or any 40 point combo
◦ (decrease from proposed 60 points)
Only 20 points required for:◦ Small, rural, HPSA
◦ Non-patient facing specialties
Preferential scoring if Activity done via CEHRT
2017 – Required to only report on 1 93 different choices
Improvement Activities: Examples
ACTIVITY NAMEACTIVITY WEIGHTING
Use of patient safety tools
Consultation of Physician Drug Monitoring Program (PDMP)
Medium
High
Use of QCDR data for ongoing practice assessment and improvements Medium
Leveraging a QCDR for use of standard questionnaires Medium
Implementation of use of specialist reports back to referring clinician or group to close referral loop Medium
Implementation of fall screening and assessment programs Medium
Engage patients and families to guide improvement in the system of care. Medium
Engagement of new Medicaid patients and follow-up High
Collection and use of patient experience and satisfaction data on access Medium
Care transition documentation practice improvements Medium
Annual registration in the Prescription Drug Monitoring Program Medium
Care coordination agreements that promote improvements in patient tracking across settings Medium
https://qpp.cms.gov/measures/iaNeed 40 points. Medium activity (the vast majority) are 10 points; high weighting is 20 points.
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https://qpp.cms.gov/measures/aci
“We intend for the information on cost to be actionable by clinicians . . . improving the delivery of high-value care and . . .smarter spending “
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CostQRUR: Quality and Resource Use ReportsNo reporting required; will be calculated from claims data
www.CMS.gov
Cost: Key Points
Cost containment motivates CMS Timely access to cost data remains a
challenge for clinicians Score based on episode- specific claims Attribution may remain an issue Look to bundle models for optimizing
costs, e.g. implant costs, length of stay, post-acute care/rehab
Reporting Options
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Adjustments:
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Small Practice Implications
Exempt from reporting in 2017 if treating:Fewer than 100 Medicare beneficiaries
-OR-Less than $30,000 in billing
Estimated that this represents 32.5% of physicians but accounts for only 5% of Medicare spending
Cost of non-compliance? Recognize 2017 as a pacifying transition
year Anticipate ongoing regulatory adjustments Cost will accelerate to 30% by 2019 Threshold of #/$ for reporting may change What is the cost of compliance vs.
Medicare reimbursement in YOUR practice?
Value-Based Reimbursement:
Alternative Payment Models (APMs)
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APMs:
But, tough to meet the thresholds of participation:◦ 2019 and 2020, must have 25% of Part B
payments for covered professional services furnished by APM that meets criteria of eligible alternative payment entity. ◦ 2021/2022 50% of Part B payments ◦ 2023 onward 75% of Part B payments
APMs & Ortho
Bundles: CJR, SHFFT Accountable Care Organizations◦ Seeing some activity◦ May work with primary care hitting the marks
Future Models◦ Physician-Focused Payment Model Technical
Advisory Committee (PTAC)◦ ACS/Brandeis Groupers
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Why an ACO could work:
CJR & SHFFT
Comprehensive Care for Joint Replacement (CJR) Hospital Initiator (owner) of bundle; includes all
services associated with inpatient & post-acute care Mandatory in 67 markets (1/3rd of all markets in USA)
Retrospective Payment Design, requires Quality Thresholds
Financial Options/Gainsharing with physicians and “collaborators” this offers the potential pathway for surgeons to take risk & meet APM/A-APM requirement
Includes hemis/THR for fx but with a higher target price
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SHFFT: Surgical Hip/Femur Fracture
Mirrors CJR: locations, quality measures DRGs 480-482. Does not include hemi/THR
done for fx (under CJR) Potential as an APM in 2018, earn the
incentive payment beginning in performance year 2019
Potential as an A-APM as early as performance year 2018 if collaborate with participant hospitals in Advanced APM path.
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Surgeon readiness for APMs/ Risk-sharing Collaborative Environment Proper systems/processes◦ Registries◦ Managing the entire care continuum (post-
acute care) ◦ Careful co-management by hospital and
surgeon Contracts & Relationships with SNF &
Home Health Cost Monitoring DATA: cost, complications
Alexandra(Alexe)Page,M.D.
alexe.page@gmail.com(619)8408973
MusculoskeletalHealthCareSolutions