MACRA - What’s In Store for Independent Practices
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Transcript of MACRA - What’s In Store for Independent Practices
webinar
MACRAWhat’s In Store for Independent PracticesPresented by John Lynn July 13, 2016
@GoKareo
Agenda
2
Agenda
2
• Welcome & Introductions• MACRA• How Kareo Can Help• Your Questions
@GoKareo 33
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Speaker
John Lynn Editor & Founder
HealthcareScene.com, a network of 10 EHR and HIT blogs
Co-founder of InfluentialNetworks.com & Physia.com
Blogs have published over 10,000 healthcare IT posts with more than 18 million views
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Agenda
5
Agenda
5
• Welcome & Introductions• MACRA• How Kareo Can Help• Your Questions
@GoKareo 66
Move to Value and Quality
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What is MACRA?
Medicare Access and CHIP Reauthorization Act of 2015
• Replaces Sustainable Growth Rate (SGR) and the annual "Doc Fix"
• Single Framework - Quality Payment ProgramStreamlines Multiple Quality Reporting Programs Into
• APMs (Advanced Alternative Payment Models)• MIPS (Merit-based Incentive Payment System)
Currently a Proposed Rule
• Public Comment Period Ended June 27th
• Final Rule – October 2016?
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Most Small Practices Will Do MIPS!
CMS Expects Most Will Move from MIPS to APM Over Time
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Are You Part of an APM?
Who's Considered an Advanced APM in 2017?
• Shared Savings Program (Tracks 2 and 3)
• Next Generation ACO Model• Comprehensive ESRD Care (CEC) (large
dialysis organization agreement)• Comprehensive Primary Care Plus
(CPC+)• Oncology Care Model (OCM) (two-sided
risk track available in 2018)
@GoKareo 1010
What’s the Benefit of Being an Advanced APM?
•Up to 5% Bonus Starting in 2019 through 2024•Higher Fee Schedule Update in 2026
The MACRA APM Creates Extra Incentives, It Doesn't Change Current APM Functions or
Rewards Value
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Most Small Practices Won’t be Advanced APMs
Advice for Those Who Might Be in an APM:
• Consult Your ACO or other APM OrganizationAsk:
• Are You a Qualified APM Participant (QP)?
Only Advanced APMs (QPs) Are Excluded from MIPS
@GoKareo 1212
MIPS Details
Replaces 3 Programs:
• PQRS• Medicare EHR Incentive Program (Meaningful Use)• Value-Based Payment Modifier (VBM)
These Programs Go Through 2018
New Program:
• Clinical Practice Improvement Activities (CPIA)
@GoKareo 1313
MIPS Details
Worth Noting:
• Medicaid EHR Incentive Program will Continue• Medicare EHR Incentive Program for Hospitals Will
ContinueImmediate Timeline:
• First Performance Period is 2017• MIPS Adjustments Happening in 2019
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Who's Eligible for MIPS?
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Who's Not Eligible for MIPS?
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What's the MIPS Incentive or Penalty?
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MIPS - 4 Performance Categories
Note: “Resource Use” is sometimes called “Cost”
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Performance Category Weighting
MIPS 100 Point Scale
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MIPS Composite Performance Score
• MIPS Performance Score Compared to Threshold - Determines Adjustment You Receive
• CMS Intends to Publish the Benchmarks and Thresholds Prior to 2017
• Gives Credit for Partial Performance• Scaling Factor to Keep Program Budget Neutral• Exceptional Performance Incentive ($500 Million
Available)
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Quality Performance Category
PQRS Replacement
• Reduction from 9 to 6 measures• No Domain Requirement
Changes
• Close to 300 Measures Available• Specialty Specific Measure Sets• Year 1 Weight - 50%
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Resource Use (Cost) Category
Value Modifier ReplacementNo Data Submission Required
• Calculated Based on ClaimsChanges:
• Added 40+ Episodic Specific Measures• Year 1 Weight - 10%
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Clinical Practice Improvement Activities Category
New Category (CPIA)
• 90+ Activities to Choose From• Minimum of One Activity• Small practices (15 or fewer professionals)
- Two Activities = Full Credit
• Patient Centered Medical Home = Full Credit• APM Participation = 50% Credit• Year 1 Weight - 15%
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Advancing Care Information Category
EHR Incentive Program (Meaningful Use) ReplacementChanges:
• May Participate as Individual or Group• Year 1 Weight - 25%
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Advancing Care Information Scoring
Score within a Score (25% of Total MACRA Score)
@GoKareo 2525
Advancing Care Information Still Includes
Base Score (Reporting)
• Protecting PHI• ePrescribing• Patient Access• Patient Engagement• HIE• Public Health and Clinical Data Registry Reporting
Performance Score
• Patient Electronic Access• Coordination of Care through Patient Engagement• HIE
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Advancing Care Information Changes
• Removed "All or Nothing" Approach from EHR (Meaningful Use) Program
• Removed Redundant Measures• Eliminated CPOE and CDS Objectives• Reduced the Number of Required Public Health
Registries
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Small Practice Support for MACRA
$20 million/year from 2016-2020 to Small Practices
• Provides Technical Assistance with MIPS or Transition to an APM
Concept of a "Virtual Group"
• Not Available Until 2nd Year of ProgramAccommodations for Small Practice Reporting for:
• Quality Category• Cost Category• Clinical Practice Improvement Category
@GoKareo 2828
MACRA Comment Period
134 Physician Events – 60,000 Participants3,710 Formal Comments ReceivedGeneral Feedback
• Delay the January 1, 2017 Start Date• 90 Day Reporting Period for 1st Year of Advancing Care
Information• MU Stage 3 Requirements Should Be Delayed Until
2018• More Simplification• APMs Aren’t Accessible to Most (Which is Bad)• Data Blocking Attestation Requirement is Controversial
@GoKareo 2929
Medicare Fee Schedule Changes
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How Do You Fit Into MACRA?
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Agenda
31
Agenda
31
• Welcome & Introductions• MACRA• How Kareo Can Help• Your Questions
@GoKareo 3232
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Agenda
37
Agenda
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• Welcome & Introductions• MACRA• How Kareo Can Help• Your Questions
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