This event is live as of XYZ

10 Things You Need to Know About MIPS and APM

Emily JamesManager Meaningful Use Performance

• Medicare Access and CHIP Reauthorization Act (MACRA) signed into law April 16th, 2015

• Repealed the flawed sustainable growth rate (SGR) formula

• Extends Children’s Health Insurance Program (CHIP) for two years

• New two-track Medicare physician payment system emphasizing value-based payment models

Landmark legislation alters howMedicare reimburses physicians

4

MU PQRS VMMIPSMerit-Based Incentive Payment

System

Consolidates three existing programs, adds in additional performance category

APMAlternative Payment Models

Incentive payments available to qualified and eligible APM

1

2

1 When do I start?

“The folks at CMS are very smart and  well meaning, but it’s hard for me to imagine implementing the NPRM as written in the timeframes suggested.”

-John Halamka, MD, MSCIO Beth Israel Deaconess Medical Center

Dean for Technology Harvard Medical School6

Nov 2016:CMS to release final rule

May 2016:You start now Jan 1st 2017:

QPP proposed ruling to begin

Learning

Preparing

Performing

Reporting

8 months

2 Who is eligible?

8

MIPS APM• Next Generation

ACO• Comprehensive

Primary Care Plus (CPC+)

• Medicare Shared Savings Program (MSSP) Tracks 2 & 3

• Oncology Care Model with two-sided risk

• Comprehensive ESRD Care (for larger dialysis organizations)

• Physicians• PAs• NPs• Clinical nurse

specialists• CRNs• Anesthetists• Groups that

include such clinicians

3 Which track do I choose?

Everyone reports MIPS

in 2017.

4 What is the reporting period?

5 What are the MIPS payment adjustments?

-1% +1%

Maximum Provider Penalties and Bonuses

14

30%

20%

10%

0%

-10%

Paym

ent A

djus

tmen

t

-4%4%

12%

2019

-5%

5%

15%

2020

-7%

7%

21%

2021

-9%

9%

27%

2022

High performers eligible

for additional incentive

Budget neutrality adjustment: Scaling factor up to 3x may be applied to upward adjustment to ensure payout pool equals penalty pool

Non-reporting

groups given lowest score

6 Then, what will my payment adjustment be?

16

17

87% of solo practitioners are

expected to see a negative

adjustment.

7 What about APMs?

Bundled PaymentsPCMHMSSP Tracks 2 and 3 (TIN)

Oncology Care Model (OCM) one-sided risk arrangement

CMS Innovation Center initiativesNext Generation ACO (EC Level)

Comprehensive Primary Care Plus (CPC+)

Oncology Care Model (OCM) two-sided risk arrangement

Comprehensive ESRD Care (CEC) (LDO arrangement)

MSSP Track 1 (TIN)Comprehensive ESRD Care (CEC) (non-LDO arrangement) ?

8 What will this cost?

21

$723.50total estimated annual cost per MIPS eligible

clinician.

11 burden hoursper MIPS EC for EHR data

submission.(for Quality Performance category alone)

9 So, Meaningful Use is gone?

24

MU

10

Last, but not least…

26

27

28

29

30

$4.8 billionCollections posted per

quarter 

195,900+Active interfaces

78,158Providers on our network

69 million Patient records1.2 billion

Data transactions processed annually

31

4,752employees

8locations

5services

Specialized teams at athenahealth all across the

country have your back

32

2

3

4

5

Our web-based solution offers visibility into our clients’ performance, with network-wide adjustments

We’ve optimized the quality measure selection through an automatic model

We will do your MIPS and APM reporting for you

We’ve done this before: we lead the industry with our clients’ success in MU and PQRS

1 We’ve already started to estimate our current clients’ performance

33

Currently estimating our clients’ performance in real-time

athenaNet provider performance on Meaningful Use Stage 2 measure: Use Secure Electronic Messaging

NETWORK WIDE CHANGES:1. NEW FUNCTION: Now easier for practices to

register patients to the patient portal.2. FUNCTION UPDATE: Now easier for providers

to send patients secure messages through the patient portal.

100%

90%

80%

70%

OCT. 2014 NOV. 2014 DEC. 2014

35

$723.50

saved

11burden hours saved

We will take on your busy work

36

We will make sense of the 200 measures and choose which are right for

you

37

Historically, our clients perform better.

Meaningful Use Stage 2 attestation

% of HCPs avoidingPQRS penalties in 2015

NATIONAL AVERAGE

60%ATHENAHEALTH

CLIENTS

93.6%NATIONAL AVERAGE

33%ATHENAHEALTH

CLIENTS

98.2%

Want more? Join Us!

MIPS Deep DiveWednesday June 1st

Hosted by Ruby MaaSenior Product Innovation Association

Thank You