Making Sense of MACRA - Health CatalystMaking Sense of MACRA May 10, 2016 Making Sense of MACRA May...

MakingSenseofMACRAMay10,2016

MakingSenseofMACRAMay10,2016[00:01]

[ChrisKeller]Thankyoufor joiningustodayandwelcometothewebinar. This isthe2016HealthCatalyst®WebinarSeries.Asaquickintroduction,HealthCatalyst®isanoutcomesimprovementcompanyfocusingonhealthcaredatawarehousinginanalytics.MynameisChrisKellerandIwillbeyourmoderatortoday.

Our webinars are intended to be educational opportunities to explore the many facets ofhealthcare transformation, culminating in our annual Healthcare Analytics Summit thisSeptember6ththroughthe8thinSaltLakeCity.Thoseofyouwhoattendedourwebinarsinthepastcoupleofyearsmayrememberthatweheldsummerregistrationgiveawaysattheendofsomewebinarsleadinguptothesummit.Wewillbedoingthatagaintoday.

Now, let us begin with today's webinar. Making Sense of the NewMACRA AnnouncementpresentedbyBobbiBrown,VicePresidentofFinancialEngagementswithcommentaryfromDr.BryanOshiro,ChiefMedicalOfficer atHealthCatalyst®. Throughoutourpresentation today,weencourageyou to interactwithourpresenterby typing inquestionsandcommentsusingthequestions pane in your control panel. We will be answering questions at the end ofthepresentation during our questions and answers time. We are recording today's sessionandshortly after the event, you will receive an email with links to the recorded on-demand

webinar, thepresentationslideswith thepoll resultsandthenamesof thesummitgiveawaywinners.Wewillbeprovidingthistranscripttothiswebinarandwewillsendoutanotificationoncethisisavailable.Also,youcanfollowusonTwitter.Ourhandleis@HealthCatalyst.

Before IturnthetimeovertoBobbi,wehavetwopollquestions. Letmegoaheadand loadthatfirstpollquestionrightnow.

Whatisyourprimaryfunctionalareaofexpertise?[01:47]

What isyourprimaryfunctionalareaofexpertise? Wehavefiveoptions,clinical, finance, IT,executive,orother.Wewillgivepeopleafewmomentstoanswerthatquestion.

Arewegood?Wewillclosethatpollquestionandshowtheresults.

PollResults[02:07]

Alright. Wehavegotanicemixofpeople today. Fewer in finance than typical. 21percentclinical,8percent finance,19percent IT,25percentexecutive,and27percentother. Thankyou.

Now,ontooursecondpollquestionthatpertainstotoday'stopic.

PollQuestion#1HowreadyareyoutoparticipateinMACRA?[02:31]

How ready are you to participate inMACRA? Five options. Not at all, somewhat, unsure,ready,orveryready.Wewillgiveyouafewmoremomentstoanswerthatquestion.

Verygood.We'vegotgreatresponsehere.

Okay.Wewillgoaheadandclosethatpollandsharetheresults.

© 2017 Health Catalyst Proprietary and Confidential

PollResults[02:56]

Whatdoyouthinkaboutthat,Bobbi?

[BobbiBrown]Wow! Wecanseea lot intheunsurecategory. Wedohaveacouplepeople,1percentareveryready.Sothat'sgreat.Hopefullytheycansharesomefeedbackwithustodayaswearegoingthroughthis.Andthenotatall,I'mgladyou'rehere.That'swhywearehere,totrytohelpout.Andthesomewhatcategory,wewillgettothere.

[ChrisKeller]Verygood.Thankyou,Bobbi.Wewillgoaheadandturnthetimeovertoyounowtopresent.

MakingSenseofMACRA[03:30]

[BobbiBrown]Okay.MakingSenseofMACRA.It'sagreatdayhereinSaltLake.Wehavethiscutelittleboyuponthescreen.Heisreadytotakeonanything,justlikewearereadytotakeonMACRA.

Question:Whoreads962pagesofregulations?[03:38]


Sothefirstthingthathappened,Ithinkitcameoutmaybetwoweeksago,theregulation,theproposedregulationcameoutandI just, Idon’tknow. IwishIcouldaskapollofhowmanypeoplereadthe962pagesofregulations.Ihopenotalotofyou.Itisaninterestingscenarioofpeople. WhenIhavebeeninthisbusinessawhile,asyoucanprobablytell ifyoureadthewrite-up about this webinar, and we used to have a fight between some partners at ourinstanceandpartnersat(04:12)totrytoseewhocouldgetthefederalregisteredthefastestandreaditandtheninterpretitandgetitbackouttoourclientsquickly.Wedidn'thavetodothatanymore.It'sallonlinewhichmeansyoucanstayupallnightandjustdialinandlookatthem.ButI'maprettycalmpersonandI'mprettycalmthroughallthisandIhavetosayIwentthroughtheregulationsonceandthenIhadtogoawayandcomeback.SothecomingbackiswhatyouaregoingtoseeasIwentthroughandfiguredoutwhatisgoingon.

PurposeofHRBill01[04:45]

Thewholepointofthis,itwasHouseofRepresentativesBill02.ItwaspassedlastyearinAprilof2015.AndIwanttocomebacktothisattheend.Theywanttooffermultiplepathwaysforrisk and reward, theywant tominimize reportingburdens and streamlinemultipleprogramsandthenrewardcliniciansforvalueovervolume.Asanyonewilltellyouwhentheyreadthese,thesearegreat.Thedevilisinthedetails.


Acronyms[05:20]

Solet'stalkalittlebitaboutthosedetails.Butfirst,whenyoureadthis,youkindofthinkwhatisthisandyouareneversurewhethertosay,M-A-C-R-AorMACRAorSGRorMIPSorhowtosayit.Wekindofdevelopedourownlittlelanguagearoundthis.ButMACRAistheMedicareAccessandCHIPReauthorizationActof2015.Itdidpassforanothertwoyears,theChildren'sHealth Act, which is always great, but we are not going to focus on that. The SustainableGrowthRate iswhatgot replacedbyMACRA. AndMIPS isaMerit-based IncentivePaymentSystem. APM isAlternativePaymentModelsand theysnackeda little something inonus inthis. There are alternative payment models and there are advanced alternative paymentmodels, which we are going to talk about. And Eligible Professional became the EligibleClinician.SoifyouwereanEP,youareanECnow.


GoalsofCMS[06:22]

Soagain,overall goals forCMS, I think it's just great that theyput theseout there last year.Theysaidby2018,wewanttobe90percentbasedonqualityandwewanttohave50percentbased on alternative payment. Right now, just in context, 22 percent of the payments thatMedicaremakesgotophysician.Sothatisthesegmentthatwearetalkingaboutandtheyaretalkingaboutoverallontheslideontherightbutnowwearegoingtobefocusedonthis22percentofpayments,approximately$138billionayear.Andofcourse,MedicarewantstogettheprivatesectorcommercialstomatchthisandIdonotknowiftoomanycommercialpayerswillgetinandhavethislevelofregulationarounditbuttherearesomethingsthattheycando,definitelytyingtoquality,usingsomeofthesamemetrics,whichwouldbewonderful,andseewherewegofromthere.


GoalsofCMS[07:20]

Again, these goals, cannot argue with these, we want better care, smarter spending andhealthier people. And they are going to go that via incentives, the care delivery, and theinformationsharing.

Reactions[07:32]



Thereactions,I'mgoingtoletDr.Oshirospeakalittlebitaboutthiswhen,likeIsaid,itwaskindofafrenzywhenthisstufffirstcomesout,andwhatdowethinkaboutit.AndIputsomeupontheboardandletDr.Oshiro.

[Dr.BryanOshiro]Yes,thankyou,Bobbi. Youknow, it'squite interestingwhenyougoandtalktophysicians. Italktomanyofthemandtheyreallydonotunderstandwhattheactualchangesare.ThereisamisunderstandingthatbecauseofthenewMACRAOSandpaymentschedulesandsoforththatareproposedtobechanged,thattheythoughtthatmeaningfuluseevenwasgoingaway.Sothereisa lotofconfusion. Butforthemostpart, it is interestingtomethatalthoughStevenStack,thePresidentofAMA,says,"Thisisthemostprofoundchangetophysiciancompensationinmorethan25yearsandthereisgoingtobealotofangerandfrustration." Ithinkalotofthatstemsfromthefactthatpeople justdonotunderstand itandtheyarereallynotpayingthatmuchattentiontoit.Soitisjustquiteaninterestingenvironmentinwhichwelive.

[BobbiBrown]Okay.Sojustafew,youknow,tryingtomakeitsimple,andthisone,Iwantyoutothinkabout,"Feedbackmechanismsaretoofarremovedfromtheperformanceyear." Again, let'scomebacktothatone.

PerformanceYear2017[08:55]

Theperformanceyear, it's2017. Andguesswhat? Howmanymonthsaway is that? Sevenmonthsawayandwearegoingtostartintoaperformanceyear.So,onethingthatpotentially


couldhappenwithyourfeedbackandparticularlywiththisbeingelectionyearismaybesomedelays,maybeitwillnotstartJanuary1st.Idon’tknow.Weshouldtakeapollonthatandseewhenitisgoingtoactuallystart.Butagain,ifIgetacrossanythingtoday,2017isaroundthecornerandthatiswhentheperformanceyearisgoingtobe.Youdonotgetpaidthiswayuntil2019. Soyoutendtothink,huh! Icangotosleepforawhile. No,youcannotbecausetheperformanceyearisgoingtobe2017.

AdditionalAspects[09:38]

Someadditionalaspectsofthis,CMShasagreedtogive$20millionayeartechnicalassistantsforsmallpracticesandtherealso,theyputin$75milliontohavephysiciangroupsgettogetherto improvethequalityofmeasurementdevelopment,which isgood. Bothofthosearegoodthings.Wewillhavetofigureouthowtotapintothem.


TwoTracksofMACRA[10:00]

Thereisamilliondifferentchartsoutthere.AndIneedtosay,CMS,ifyoujustgotocms.govandtype inMACRA,there isareallygood informationoutthere. Theyaredoingreallygoodwebinars.IttendstobealotofrepetitionofregulationsthemselfwhichIusedtolovetodo,justsitthereandsay,4percent,5percent,7percent.Soyouneedthatpieceofitandthenyoualsoneedthepieceofwhatyouaregoingtodowithallthis.

Soagain,there'stwotracksinMACRA,MIPSortheAPMforqualifiedproviders.AndifyougointotheMIPStrack,whichiswheremost–youdon’treallygettochoose.MedicareisgoingtoputyouprobablyinMIPS.Andwe'lltalkaboutwhichtrackandhowyougetintothedifferenttracks.Andthenagain,Imentionedtheperformanceyearis2017.Thenstarting2019forMIPSyourpaymentcangoupordownby4percent,5percent,7percent,9percent,thenitstaysat9percent,andyoucaneitherbeplusorminusthosenumbers,youcanbeneutral,getnothingincreaseonyourfeeschedule,andthenthereisalsoapotentialforabonus,whichwewillgointo.

So they did actually give out regulations past this date, but to me it was just toomuch. Ithought,wellwhocaresin2026ifIamgoingtoget0.75003percentincrease.Iwanttofocusontoday.SoIdidnotevenputthoseinhere.

Onthevalue-basedside,5percentbonusandatfirstIwasthinking,ahyeah,ifeverybodygointothevalue-basedside,butitisnotgoingtobeaseasythatitendsupinthattrack.


CrossOverBetweentheTracks[11:53]

Andthereissomecross-overbetweenthetracks.IfyouareintheMIPsandyouarealsoinanalternativepaymentprogram,youwillreceivecreditforsomeofthosethings.Ifyouareinanadvancedpaymentandyoufallshort,youcouldstillgettheMIPSpaymentandtheyhavetriedto align the quality payment program between the two so that the measurements are thesame.


ProposedRulemaking[12:17]

Importantpart,proposedrulemaking.Thepubliccommentary,wehavefromnowuntilJunetogive our commentary, and then the final regulations will be published in, again, November2016,andthat'snotalotoftimeperioduntilJanuary,fromNovembertoJanuary.Soagain,wewillhaveanotherfranticreadingofallthoseregulationswhenthefinalscomeout.Igaveyoutheweb address here to submit any comments that youmay have to CMS. They are reallylisteningtopeopleandtryingtotakeintoaccounteverybody'sfeedback.


Reporting[12:59]

Thereportingperiodwillbeonceayearandyouareonlygoingtoseeresultsonceayear.Sohence,thatcommenttherethatwasmadeearlier.ThefirstfeedbackperiodwillbeJuly2017,whichwill be data from previous two years. Your second feedback reportwill be in July of2018,whichwillbeon theactualdata. And just to remember,allof thisdata isgoing tobemadepublicanditisgoingtobeonPhysicianCompare.WhenMedicarefirststartedputtingallthisdataoutthere,Iwasworkingatasystem,I'mafinanceperson,andmyboss,obviouslyhewas a financepersonbut he said, "Get out there and findout everything that is on thewebaboutusbecauseIdon’tlikethis,andmakesurethatthedataiscorrect."Soyouwillwanttobethinkingalongthesameway.YouwanttomakesurethatreportsthatMedicaresendsyou,youlookatthembecausetheyaregoingtobemadepublic.


MIPS,Merit-basedIncentivePaymentSystem[13:51]

Okay. Let us talk about these two tracks now. We have this MIPS, Merit-based IncentivePaymentSystem.IhavetosayIlikeMIPS.Ilikesayingthat.Thiswillbethedefault.

Eligibility[14:07]


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And who is eligible for this in years 1 and 2? It's physicians, physician assistants, nursepractitioners, theclinicalnurseand theCRNA. And then theyareproposinganexpansion inyearthree.SoforadditionalPT,OT,socialworkers,andthenursemidwives.

[BryanOshiro]Bobbi,letmeinsertaquestionthatanaudiencememberasked,whichis,whatdoesbaseyearmean?

[BobbiBrown]Base yearwill be2017generally. And sometimes I'm interchanging thewordbase year andperformance year and I really should not. It really is the performance year, which is 2017,becauseintheotherprogram,thereisalsoabaseyearofpaymenttobebasedon2018.Soitisgenerally2017andIwilltrynottousethewordbaseandperformanceyear.

[BryanOshiro]The other, I think you are going to talk about exceptions but there is an exception for lowvolumeprovidersthatdonotchargemorethan$10,000andprovidecareforlessthanhundredMedicarepatientsinoneyear.Sotheydohavethatprovisiontheretoo.

ExceptionforMIPS[15:38]

[BobbiBrown]Yes,andthescreenrightnow,wehaveexceptionforMIPS.IfitisyourfirstyearofMedicareparticipation,youwillnotbe,andthenthislowvolumethresholdthatDr.Oshirotalkedabout.


Soahundredpatientsor$10,000.AndthenifyouareparticipatingintheadvancedAPM,youwillnotbeinMIPS.ButithastobetheadvancedAPM,notjustAPMadvanced.

MeasurementCompositePerformanceScore(CPS)[15:59]

Okay. So when you are in MIPS, there is a composite score and it's weighted and that'sprobably themost important thing youneed to know. I amgoing to droneon about a fewmorethingsbutitisquality,cost,thisisanewone,clinicalpracticeimprovementactivities,andadvancingcareinformation,whichistheoldmeaningfuluse.Andthentheweightisoverthereandthesedochangebyyear.Eventually,costgoesuphigherandqualitygoesdownlowerandtheothertwoseemtostayconstantoverthetimeperiod.


Quality–weighted50%[16:33]

Soifwetalkaboutquality,thequalitymetricswere,ifyouareusedtoPQRS,youareusedtosubmittingwhatisninemeasures,withthedomainnow,it isdowntosixmeasures,andtheyaregivingyouaselectionofover300measuresandtheyareactuallyinthelast200pagesoftheregulation,ifyouwanttolookatthem.Youdohavetohaveonecross-cuttingmeasureandone outcomemeasure. Example of a cross-cutting means that it impacts a lot of differentpractices.Soacareplan–doIhaveacareplan.

Atoutcomemeasure,again,CMSactuallydefineswhatisaprocessmeasureandanoutcomemeasure. Soforanoutcomemeasure inthiscase iscataracts. Aftercataractsurgery, Ihavebettervisualacuitywithin90days.Soagain,thisisgoingtobeweighted50percent.


Stakeholders[17:23]

Thestakeholdersthattheywentto,theytalkedto6,000people.Andthereiswhattheycalledameasurementdocumentoutthere,itis80pageslong.Soifyoulikedocuments.Thisisnotaslongastheregulation,butitdoesgiveyoutheirbasisforhowtheydevelopsomeofthesemeasuresandwhotheytalktoandwhattheircriteriawere.


InitialPrioritiesforMeasureDevelopmentClinicalCareandSafety[17:49]

Andjusttalkingaboutcriteria,Ithinkit isinterestingtoalwaysstartoutwithwhatweretheytrying to do, trying to have outcome measures, as I mentioned. On the safety measure, Icannotimaginewearenotgoingtoseemoreonopiates,justeverythingthat'sinthenewstoimportantdrugclassessafetyrelatedtoimportantdrugclasses.


Continued-InitialPrioritiesCareCoordination,PatientandcaregiverexperienceandAffordablecare[18:11]

Care coordination, telehealth, PROMs. No, you are not going to the prom but those arePatient-ReportedOutcomeMeasures.Ipersonallywassicklastcoupleyearsago.IactuallyhadsepsisandIhadtogobacktomydoctorandtheygavemealittlelaptop,alittleiPad,andmademefillouthowIwasdoing,andIthought,ohthisisthestupidestthingintheworld,andIcouldtellalotofpatientsinthewaitingroomwerehavingalotofdifficultydoingthis.Butmyfriend,whoisanurse,shesaid,no,that'sextremelyimportant,yourpatient-reportedoutcomes,howfaryoucanwalk, ifyoucanpickupyourshoppingbag, that'sextremely important forhertoknowandmakesurethatI'mmakingimprovementinthoseareas. SoitwasmoreimportantthanwhatIrealized.SoI'mlearningsomethingneweveryday.Affordablecare,whereareweoverusingareas,thehighimaging,areweoverusinganything.


Continued-InitialPrioritiesPopulationHealthandPrevention[19:10]

And finally our population, we know we want to really get into population detection andpreventionofchronicdisease. Soagain,allof thesethingswent intothequalitymetricsandhow,whichonestheypick.


Resource–weighted10%[19:23]

Theresource,thisisthecauseone.It'sjustweighted10percentthisyearandtheyaregoingtocompareresourcesusedtotreatsimilarcareepisodesandclinicalconditionsacrosspractices.Theywillriskadjustandtheywillcalculatethisnumberforyou,andIdonotknowifthatisagoodthingorabadthing,ifyoulikesomebodycalculatenumbersforyou.Buttheyhavetheinformationfromclaimsandtheywillcalculateitforyou.


MSPB[19:46]

Right now, there is a thing called the Medicare Spend from Beneficiary, another acronym,MSPB,andit ispublic information. Youcanget itrightnowforallthehospitalsanditshowsyouwhattheyarelookingatandlookingatthreedaysprior,thehospitalandthen30daysoutand they could change any of these and looking at your hospital compared to your statecomparedtoyournation.So,thedataisthere.Theyaregoingtostart–theyalsowanttostartdoingitbyconditions,likeforheartfailure,forCOPD.Sotheyarepartofthisregulation,hadsomegroupersinitofhowtheymightpotentiallygroup40to50differentconditions.Sothatiscomingdownthepipeandthatisgoingtobepartofthepieceontheresourceuse.


ClinicalPracticeImprovementActivity(CPIA)–Weighted15%[20:37]

Theclinicalpracticeimprovementactivity,CPIA,it's15percent.Itisnotalotofdetailbuttheydohave90plusactivities,thingslikeexpandedpatientaccess. Soforthingslikedoyouhaveweekend hours, do you have hours at night, do you have 24-hour access. For the carecoordination, have you implemented practices that document this care coordination. Thebeneficiaryengagement,we talkedabout toolswhere thebeneficiary is involved. Obviously,patientsafety.Therearedifferentprogramsyoucanparticipateinthatwillcountasthis.Youonlyhavetopickone.WhatIcouldnotfindoutfromtheregulationsishowlongyouhavetodoit.Itlookedliketheywereproposingthatyoudoitatleast90daysbuthopefullyinthefinalregulation,thatwillcomeoutandwewillseehowlongwehavetodosomeofthesethings.Butagain,allofthesearethingsthatarebeneficialtothepatientandthebeneficiary.


AdvancingCareInformation–Weighted25%[21:49]

The final advancing care information, weighted 25 percent. This is what used to be calledMeaningfulUseorMU.SoyouaregoingtohavetouseacertifiedEHRinyourpractice.Thereisgoingtobeemphasisoninteroperabilityandinformationexchangeandthereisnotanymorequarterly reporting and it is not an all or nothing and they took out the CPOE and ClinicalDecisionSupport.


MeaningfulUse[22:18]

So,inthebeginningoftheyear,wehadalotofflurrybecausetheactingadministratorofCMS,Andy Slavittwrote, "Meaningful Use, as it existed,will be effectively over and replacedwithsomethingbetter."Anditwasagreattweet.Ithinkweallgotexcited.Itisnotover.Westillaregoingtobereportingmeasures.Butagain,thefocusistowardstheuseoftechnologyandtheoutcomestheyaregoingtogiveourpatients.


SixObjectivesofAdvancingCareInformation[22:46]

Soagain,whatcriteriaarewelookingatinthisadvancingcareinformation–protectionoftheinformation,patienthavingelectronicaccess, theelectronicprescribing,coordinationofcare,and information exchange and public health and clinical data registry. They eased back onsome of these registry requirements and some of the public health as you go through theregulations.


Technology[23:11]

WhatareyougoingtohavetodostartinginJanuaryof2017.Again,thecertifiedEHRreporteight,ifyouareinstage2orsixinstage3,andyouaregoingtohavetoattestthatyouhavecooperated with the surveillance and that you have cooperated with health informationexchangeandinformationblocking.


Scoring[23:33]

Okay.Now,allofthesegotogether.Thequality,thecost,theclinicalpracticeimprovement,and theadvancing care, andyougetpoints, and thenyouget scoredoneachone. And theadvancingcare is interestingbecausethere is60pointsforthis,theperformance is10pointsandabonusscore.Iputallthisupherejusttoletyouknowitisalittlecomplicated.Itisnotgoingtobesomethingthatwearegoingtobeabletodointhreeseconds.


MoreAboutScoring[23:58]

Then they takeall thesemeasuresandconvert themtopointsand theyaregoing to let youknow inadvancewhat the targetsaregoing tobe,which is good. Sowearegoing toknowaheadoftime.SoifIwanttobeinthattopperformance,IknowwhatIhavetodo.Youcanalsosubmit.Thesemeasurescanbedoneasagroup.Andthatisaninterestingonebecauseconsumerswanttoknowaboutindividualphysicians.Individualphysicianswanttoreportasagroup.Soitisjustaninterestingdichotomythatwehavethere.Andagain,thisMIPS,wearegoingtohavethosefourareasonazeroto100percentscaleandputthemtogetherandyouwillgetascoreforeachoneandcomeupwith,ofcourse,aCPS.


Scoring–CPS[24:46]

SoincaseyouhearaCPS,thatisyourCompositePerformanceScoreforallofthosefourareas.Andinthefirstfiveyears,thereisgoingtobe$100millionextraeachyear,or$500millionoverthe fiveyears,asanadditionalperformancebonus that isexempt frombudgetneutrality forexceptional performance. So if you really are an exceptional performer, you can really getsomeextramoneyinhere.


PaymentAdjustment[25:12]

Okay.So,whenweboilthisalldown,theyaregoingtoadjustthepaymentthenbasedonthatscore.Itisabudgetneutralprogram.Sowhoevergoesbelow,thenthatcangotothepeoplethatareabove.AndwhatIputonthere,the46percentiswhatCMShasputintheregulationaswhattheythinkthenumberofpeoplethataregoingtobebelow.Andtheinterestingthingisthatreallyvariesbypracticesize.Forthesmallpracticesize,itwasuptointhe80percentthattheythoughtweregoingtoreceiveanegativeadjustment.Foroverallpractices,allsizes,itis 46 percent, and then obviously the inverse of that is 54 percent saying that that will beperformance above and you can either be neutral or performance above and you have apotential for a bonus that will not exceed 10 percent, and they are also going to do somescalinginthis.Sotheyarenotgoingtoscaleonthedownside.Andremember,Isaid,thefirstyear,it'splusorminus4percent,andiftheydosomescaling,ifthereisalotofpeoplebelow,iftheirnumber isnotrightand it ismorepeoplebelow,thentheyareactuallygoingto let thepeopleaboveearnmoremoneytomakeabudgetneutral.Sowhatgoesoutwillbe,likeIsaid,azerosumgain.So,interesting.Goodwaywecanforecast.


APM–AlternativePaymentModel[26:41]

TheothertrackistheAlternativePaymentModel.ReallythisiswheretheAlternativePaymentModel, as you saw on the beginning, is where CMS wants us to go as an industry and theCongresswantsustogothere.Thecurrentadministrationwantsustogotothesealternativepaymentmodels,whicharethingslikeACO-bundledpayments.Wehaveacoupleofbundledpaymentmodels.Sothatiswheretheywantustogo.

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MACRAdoesnotchangeanyexistingAPMprogramsorincentives[27:11]

Now,MACRA,itisnotforhospitals,it isonlyforphysiciansanditdoesnotchangeanyoftheexistingprogramsthatareoutthere.SoifyouareinanMSSPACO,nothingischangingthere.SomeofthequalitymeasuresthatyouarereportingwillcounttowardsMACRAbutgenerallythereisnochangeinthoseprograms.


ModelsthatQualifyforAdvancedAPM[27:38]

AndasImentioned,youhavetonotjustbeinanalternativepaymentmodel,youhavetobeinan advanced alternative payment model. And right now, there are five different types ofmodels that qualify for that advance. I put themup here – the ESRD, theMedicare SharedSavingsProgramTrack2andTrack3. NotTrack1. SoifyouareinTrack1,youareprobablystill inMIPS. TheNextGenerationACOModel–21participants. TheCPCmodel,whichhasrightnowjustcameout.ThisComprehensivePrimaryCareModeljustcameoutandrightnowMedicare isaskingforpayerstoparticipateandtheyaregoingtoaskforyourparticipation, Ibelieve,startinglaterin,Ibelieveit isgoingtobeinaboutJulytheyaregoingtostartasking.Theyaregoingtopick20regionalareasinthecountry.Andifyoudoparticipateinthat,youwill be considered an advanced APM. And then there is anothermodel that is going to beavailablein2018,whichistheOncologyCare,whichisaTwo-SidedRiskModel.

Sowhattheyarereallylookingforhere,itistheriskthattheyaretalkingabout,howmuchriskareyoutaking,andthatwillqualifyyouintoanAPMmodel.


AdvancedAPMEligiblePrograms[28:55]

So,advancedAPM,howdoIqualify?Paymenthastobebasedonquality,atleast50percentofmyprovidershavetobeusingacertifiedEHR,andIhavetobearfinancialriskandtheriskhastobeatacertainmagnitude.Andthischangesagaineveryyear.Thefirstyear,Ibelieve,itis30percentrisk.Icannothaveastop-lossthatcoverstherisk.Ithastobetrueriskandtheyhave three different formulas that you have to run through. And then they also have thismedicalhomemodel,whichisagainseveralpagesofregulationthatyouhavetofilltobeabletoqualify. Sotherefore it isgoingtobedifficulttoqualify foranadvancedAPM. SowecanprobablymakesomeassumptionsthatMIPSisgoingtobethebigdeal.


ExpandedCriteria[29:52]

Not only do you have to be part of an advanced APM, but you also need to be a qualifiedprovider.Andthispartisdone,anothertestyouhavetogothrough,anditwillbedoneforthepaymentyearthatyouarein.

CMSCalculatesThresholdScore[30:11]



SohowdoIscoreinthat.Thentheyaregoingtousewhicheverscoreisthemostfavourable.Foryou,itiseitherapatientcountoradollaramount.SoofthepeoplethatItreat,howmanyof those were in a risk-based model. So for the dollars, 25 percent to be a qualifiedprofessionaland20percentonthecount,ifyouarejustcounting.Thenthereisthingcalledapartialqualifiedprofessional.Andifyouhaveeverreadaregulationandthenyourealizedatthe end, oh I do not knowwhat a partial qualified professional is…So I did goback and it issomeonethatdoesnotquitefitthecategoryoftheadvancedAPM.SoyoucanchooseMIPS,soyouwouldatleastgetsomepotentialatgettingsomeupsideonyourpayment.

MetallCriteria[31:08]

Now, if you havemet all this criteria, if you are an advanced APM and you are a qualifiedprofessionalandyoudonothavetoparticipateinMIPSandyouwillgetanautomatic5percentincreaseinyourfeeschedule.


ImpactProjectedbyCMS[31:23]

I mentioned earlier, CMS, we have approximately 761,000 professionals and they areestimatingonly30,000to90,000aregoingtofitinthatadvancedAPMmodel.Sothatisabout12percent.Theyarealsosayingthatthecostforimplementationis,theyadmit,couldleadtohigheroperationalexpensesbuttheybelievethatthecombinationofthepaymentadjustmentsandtheoverallgaininefficiencywilloffsetthoseinitialexpenditures.Andtheyalsobelievewearegoingtohaveapositiveimpactonourqualityandvalueofcare.AndIlookedatone.Thereis a chart in there by specialty on what is the plus andminus and sometimes they put thedollars inverybigdollars. WhenIdid itperphysician,this istheirestimate inoneyear,thatfirstyear,internalmedicine.Youcouldeitherlose-$1,100orbeup$1,900.Ifyouactuallygointothebonus,thenyoucouldtriplethat.Soitisontheplusside.

Theyalsomentioned,whichIthoughtwasinteresting,thattheythinkthehourstodoqualityshould take six hours of an analyst type person and one hour of the physician, that theadvancedcarerequirementshouldtakefourhoursandtheCPIAshouldtakefourhoursandImultipliedthisallout. Sotheyaresayingatahighendthatthisshouldtake$1,700inayearand they were not considering that overly burdensome. So, just interesting to impactprojectionthatCMSdidonthis.

SoIamgoingtostopnowandseeifDr.Oshirohasanycommentsthathewantstoaddbeforewetalkaboutreadiness.


[Dr.BryanOshiro]I think,Bobbi,allofthisreallypertainstothefactthat inorderforpracticestoreallybenefitfromthis,remember, it isazerosumgame. Andso, if there isnopreparationwellaheadoftime,justlookingovertheeligibleprogramsthataretherethatyourorganizationoryourgroupcanparticipateinandthinkthatyoucanmakemeaningfulimpact,issoimportantforallofthephysiciangroupstoactuallygooutthereandactuallyreadtheserulesandsoforthtoseewhattheeligiblethingsarethattheycandobecauseitisgoingtotaketimetogearupforthat.So,thereshouldnotbealotofdelay.AndIhavetoemphasizethatCMSactuallyisveryinterestedin hearing about the public comments. So, I know we stressed that before but it canoveremphasizethataswell.

Readiness[34:36]

[BobbiBrown]Okay.IsatdownandthoughtaboutsomethingsthatIwoulddo.

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PollQuestion#2HowoptimisticareyouthattheApril27thproposedregulationswillproducetheresultsthatCMSisexpectingfromMACRA?[34:42]

Oh,wehaveapollquestion.

[ChrisKeller]Thatisright.Weinsertedthisthere.Wewillgoaheadandaskthattotheaudience.Thiswillgiveyouagoodsenseofwhattheythinkaboutallthis.HowoptimisticareyouthattheApril27th proposed regulationswill produce the results thatCMS is expecting fromMACRA? Fiveoptions.1)Notatall;2)Somewhat;3)Unsure;4)Optimistic;and5)VeryOptimistic.

Wewill give the audience onemoremoment to answer this. And some people are askingquestionsabouttheslides.Wewillgivethosetoyouafterthepresentationtoday.Therewillbeanemailwiththatinformation.

Okay.Wewillgoaheadandclosethatpollandsharetheresults.

PollResults[35:23]

Sotheresultsare20percentsaidnotatall,39percentsaidsomewhat,29percentsaidunsure,13percentsaidoptimistic,andzeropercentsaidveryoptimistic.

[BobbiBrown]Again,rememberwhattheyweretryingtodo isoffermultiplepathwaysforriskandreward,minimizethereportingburdens,streamlinemultipleprograms.Sowearenotgettingridofbutwe are streamliningMeaningful Use PQRS in this value-basedmodifier, and then rewardingcliniciansforvalueovervolume.Sothatiswhatwearerespondingto.

Dr.Oshiro,anycommentsfromyouaboutthepoll?

[Dr.BryanOshiro]IthinkthatthatiswhatIwouldhaveexpectedfromwhatwearehearingandsoforth.Soyeah,Ithinkthatthatisaboutright.

[BobbiBrown]Okay.Good.Alright.

HFMAComments[36:22]

HFMA, I am a member of the Healthcare Financial Management Association. And theirpresident,JosephFifer,said,well,youknow,wearegoingtoseesomepredicableupdatesforfee schedules. It is not a hundred percent predictable because it will depend on yourperformance. Sothere isanencouragementtogetphysicians in thesenewpaymentmodelsand also to adopt the interoperable electronic health record, which is something that ournationdoesneedtodo.Healsoaskedthequestion,areweencouragingconsolidationandhealsomadeastatement,thisisnotgoingtobeacheaporasimpleparticipationagreement.


ReactionMaypushindependentphysicianstoabreakingpoint[37:01]

Andanotherreaction,maypushindependentphysicianstothebreakingpoint.Ipredictmorephysicians are going to seek employment and let the health system worry about all thesemeasuresandhavingthecertifiedEHR.Ijustwanttopracticemedicine.

Soagain,Dr.Oshiro,anycommentsonthat?

[Dr.BryanOshiro]I think that this is thewhole apathy –well not apathy but I guess the issue thatwe are allstrugglingwithasphysiciansandsoforththat just therulesandregulationsarebecomingsoburdensomeandonerousthatwefeelthatwecannotpracticemedicine.Itismoreaboutthebusinessinmedicine.Butgiventhat,itissoimportantthatweareengagedinthisbecauseitispartofoureverydaylives.Sogoingforward,Ithinkitissoimportantforustobeengagedinthisprocessandreallyunderstandtherulesandregulationsbecauseitisnotjustgoingtostop,I do not believe,with just CMS regulations and requirements. Many of the other insurancecompaniesaresoongoingtofollow.Medicaidwillsoonfollowaswell.So,thesecondgroupingthere was kind of interesting where, you know, I think while there is not a whole lot ofpregnancy-relatedissuesandyetwithsortofnursemidwivesinthatsecondgroupofproviders.So I anticipate because of majority of the government funded programs for pregnancy arethroughMedicaid,thatitisnotgoingtostopwithjustMedicare.

[BobbiBrown]Yeah.Great.Ididnotevencatchthat.Yeah,wheneveryouthinkMedicare,youdonotthinknursemidwifebutyes,great.


FinancialImpact[38:52]

Okay.Realquick.Ilovetodofinancialimpact.Sojusttakeyourrevenue,multiplyittimes4percentandthatisyourpotentialreduction.Thatisprobablynotgoingtohappen.Soifyouhad$25millionworthofMedicarerevenue,youhaveapotentialnegativeimpactofamillionbucks.Thenyoucanadjustupfromthatastowhereyouthinkyourscoringisgoingtobe.Youalsohavetothinkaboutwhatinvestmentsdoyouneedtoparticipateinthis.AndifIamunderadvancedalternativepaymentandIamaqualifiedproviderandIcanget5percent increase,shouldIexplorethatoption?WhatinvestmentsdoIneedtomaketogointothat?Sothosearethingsyouneedtobethinkingabout.


OutlineaStrategy[39:37]

Andthiswasmyto-dolist.Ioutlinedastrategy.Ihadadeadlineofquarter4andIswitchedittoquarter3.Butletusmakeitsomewherebetweenquarter3andquarter4.Byquarter4,wearealmostcloseto2017,thatisChristmastime.Sowewanttogoquarter3.

DoIknowwhichtrackIwant?Again,likeIsaid,itisnotlikeyoucanpick,butifyoucouldpick,whichonewouldyoupick?Andwhatistheimpactonmypractice?AndwhatdoIneedtodo?WhathappensifIdonothing?AndamIalreadymovingtosomevalue-basedmodel?Sowhatisgoingon,whathavewebeenlookingatasapractice,andwhathavewebeendoing.


LinkwithValueBased[40:23]

Asfaraswithvalue-based,youmaythink,okay,yeah,IwanttogobeanACO.Goodluck.Theletterof intentisdueMay20thandyourapplicationisdueMay25thfornextgeneration. ForMSSP,youcouldprobablymakeit.IcouldwritealetterbyMay31standyourapplicationisdueJuly29th.IdonotknowifIcoulddotheapplicationbyJuly29thbecauseyoureallyneedtogothrough the application process and figure out, you know, there is a lot that goes on intodecidingifyouwanttobeanACO.ButIjustputtheseupheretoletyouknow,forMedicare,thatthereisjustalotgoingonrightnowanditisrightaroundthecorner.Soyoumayjustsay,okay,wearegoingtogoinMIPSfor2017butthenin2018Iwanttoknow,soIampreparednextyear,soIcanmakealetterofintentbyMayandanapplicationthatwillbeapplicableinthefollowingyears,2018.


EducateandCommunicate[41:25]

Educate and communicate. Provide clinicianswith summarized documents. Dr. Oshirowasverykindtosay,youknow,reallyreadtheregulations.Thereisalotoutthere.ThereisalotofwebinarsoutthereandIthinkit is importanttogetabasicunderstandingthandigalittlebitdeeper.AndIamnotsureeverybodyhastodigalittlebitdeeperbutsomepeopledoneedtodigalittlebitdeeper.Maketimeinyourcurrentmeetingstotalkaboutthis.AndIthinkifyoustayinformed,itwilleasethestress.


UseProfessionalSocieties[42:04]

The professional societies, like I mentioned, CMS, they have done an outstanding job. Thefamilyphysicians,theyhaveaMACRA-readyprogramouttherethatyoucanjust–andIgaveyoutheirwebsitesandyoucanjustgeton.AHAhasbeengood.AMA,verygood.Again,andsometimes theway I think, I cannot justhearonepersonexplaining tome. IhavetohearacoupledifferentpeopleexplainingtomeandespeciallyonsomeofthoseareaslikeamIgoingtobeanalternativepaymentmodelornot. Someofthosearealittletrickyandyouwanttowork through a decision tree and there is just so much good information on all of thesewebsitesandtheyreallyaretryingtorepresentthephysiciansanddotherightthingfortheirphysiciansandmakesurethatvoicesarebeingheard.


Identifythoughtleadersanddiscuss[43:03]

I like to talk toother peoplewhenever I amagainst, and I have a person in the room that Ialwaysask.Chrisisintheroomwithme.HeisourmarketingVPhereandIalwayslookouttohimandask,wellhowshouldIshowthisorgivemesomeideas.AndIwouldsay,gooutsideofyourfield.Askotherindustrieswhohavefacedthiskindofachallengewhatdidtheydo,whatideascanyougetfromotherpeople,andjustputthatintoyourdiscussionmode.


Lookinward,knowyourstrengths[43:39]

Lookinwardandknowyourstrengths.Now,youmightsay,whyintheworlddidthisladyputthat?Thatisoneofmypaintingsbytheway.AndIhavetotellyou,Itakeallthesepaintingclasses.IhavenotinawhilebutIgotothepaintingclassesandIbuyeverything.Andiftheytellyouyouneedthreepaints,Ibuy10paints.AndIgototheclassandallmystuffisnewandIhavenewpaperorwhateverandthenIcannotdoanything.So,IknowthatIthinkIcanpaintbutIhavenotbeeninanyshows. IcannotmeasureanythingwithmypaintingbutIdohavefunwithit.Butyouneedtolooknowwithinyourownpracticeandsay,whatdoyoudowell?Andthenlookatthatdatathatshowswhatyoudowellandlookatmeasuresandyouhaveaperformanceplan inplace. Whohas accountability for this performance? Making sure thatsomeonehasaccountabilityisjustkeytoeverything.So,anytimeIamworkingonaproject,Idonotlikeprojectmanagement,IhatewhenIgetthoseemailsfrompeople,butIknowthatitissomethingthatsomeonehastohavetheaccountabilitytogetthisdonebyXdateandthisisvery true in this casebecause it is going tobehere and youarenot going tohave anythingdone.


ReviewyourQRURandMeaningfulUseSubmission[44:58]

LookatthequalityreportsandyourMeaningfulUseSubmission.Whoinyourorganizationdidthis?Whatcanyoulearnfromthatperson?Itisoftenwedidalotofinterviewingandtalkingto people who submitted these reports and I, myself, have had the joy of submitting somemeaningfulusereports,andit is interestingjusttotalktothepeopleabouthowtheygotthedataandhowitdidandhowisthatgoingtoimpactMIPS.

© 2017 Health Catalyst

Proprietary and Confidential© 2017 Health Catalyst

Proprietary and Confidential


QRURReport[45:26]

Thisisjustaqualityreport.Again,thereferenceguide,IamgivingyouthereferenceguidethatisoutthereforMedicare.Icannotaccessyourreports.Youneedyourownpasswordstogetintoyourreports,butjusttoletyouknow.

Evaluatereadiness/Execute[45:40]



Finally,wehavelookedatourreadiness,nowwearereadytogo.Youhaveaplan.Youknowwhereyoucanpotentiallygetsomepenaltiesandwhereyouneedtochange.Youhavedata,youhavebestpractices,andyouhaveanadoptionmethodology.Youaregoingtobeabletodiffuse this throughout your organization and have outcomes improvements. Outcomesimprovementswillleadtobetterqualityscoreswhichwillleadthentohigherpotentialbonusesin the MIPS program and also can lead you to some quality scores that are better in youralternativepaymentprogramswhichwillbepositiveforyouaswellfromafinancialstandpoint.

SoDr.Oshiro,doyouhaveanymorecommentsthatyouwanttomakeaboutreadinessorjustingeneralaboutthis?

[Dr.BryanOshiro]I think that you have stressed it enough but again overemphasizing the need for planning.Planning,planning,planning.Youhavetogetateamorganizedatyourpractice,thatwhoeverhasbeenworkingonmeaningfuluseandreportingrequirementsandgetthemreallyengagedandstartplanningassoonaspossibleanddonotforgettomakecommentsbecauseunlessyouactuallyunderstandthisprogram,itisgoingtobeverydifficulttomakemeaningfulcommentsthatwouldbefavourableasfaraschangingsomeoftherequirementsorsowiththeprogramitself.Sojustalotofplanningandthisyearisgoingtobecritical.

[BobbiBrown]Yes.Remembermyslide2017,getintherefast.Okay.

[ChrisKeller]Verygood.Thatwasatremendousamountofinformation,Bobbi.Thanksforsharingthat,andDr.Oshiroaswell.Beforewemovetoquestions,wehavethreeitemsofquickbusiness.

HealthcareAnalyticsSummit16[47:35]

First,thankyouforshowingthatslide,Bobbi.SomeofyouknowaboutthisandImentionedinthe beginning, we have a Healthcare Analytics Summit that will happen on September 6ththroughthe8th. Wehavetwogiveawaystoday. Iamgoingtoofferonegiveawayrightnow,whichisasingleregistrationgiveaway.


Are you interested in attending the Healthcare Analytics Summit in Salt Lake City? (singleregistration)[47:50]

IfyouareinterestedinattendingSeptember6ththroughthe8th,goaheadandfillupthispollrightnow.Thereisanexpirationtothisregistrationgiveaway,whichwewillnotifyyouintheemail.Soyouwillhavetoactquickly.

Wewillgoaheadandleavethatopenforanothermoment. Andthenwehaveasecondpollquestion for a team of three. The opportunity there is for you to bring you and two otherpeople.

Alright.Wewillclosethatpoll.Thankyou.Wewillfollowupwiththewinnerthere.

AreyouinterestedinattendingtheHealthcareAnalyticsSummitinSaltLakeCityasateam?(teamofthreeregistration)[48:20]

Andthenthesecondpolloffersourgiveawayteamofthree.Soifyoutakeonemoremomentthere.Ifyouhavequestions,pleaseaskthoseinthequestionspanel.Wewillgettothatinjustamoment.

Bobbi,wehaveprobably 40questions. Sowe are going to shift through those and you candirectsometoDr.Oshiroaswell.

Okay.Letusclosethatpoll.

How interested are you in someone from Health Catalyst® contacting you aboutademonstrationofoursolutions?[48:40]

Lastitemofbusiness,ourwebinarsaremeanttobeveryeducational.Wehopeyoufeelthattoday.Someofyouhaveasked fora follow-upandwetry tobeveryeducationalaboutourfollow-up. If you are interested in having someone from Health Catalyst® provide youwithademonstrationofanyofour solutions,pleaseanswer thispollquestion.Wewill leave thisupforafewmoreminutes.

Questions[49:02]

LetusgoaheadandmoveontoquestionsandIamgoingtopresentthosetoyou,Bobbi,andyoucanlookthroughthosewiththehelpofDr.Oshiro.Wehavegotabunchhere.

QUESTIONS ANSWERSWho would you direct within an organization? Dr.Oshirospoketothisbriefly.Whowouldyoudirecttobe the point person to understand this informationyou just talked through? What kindofprofilewouldyouexpectforthatperson?

[BobbiBrown]It has to be somebody who likes digging and likesgetting into regulations, and there are people likethat. I happen to have someone thatworks forme.He is a data architect but he really likes theseregulations. And so, finding someone, like it isinteresting that thatwill pop up in your organizationsometimes and I would say talk to people in yourorganization. Sometimes in smaller initiations it isgoing to be really tough. Many times there arephysicianswholikedoingthistypeofwork.

Dr.Oshiro,doyouhaveanycommentsonthat?

[Dr.BryanOshiro]Yeah. So this is not going to be something that youmay be used to doing and particularlywith an officepractice. So if you have amulti-specialty group, youusually have a billing department. I usually have anofficemanager, per se. But you cannot relegate thistojustthebillingandcodingpeople. Youcannotjustrelegate this to the office manager. You may havesome nurse care coordinators and nurse managers


andsoforththatareinyourpracticeaswell.Becausethis is a combination of quality improvement, costefficiencies,andpracticechangesthataregoingtogoacross your entire practice, it is important that youhave a multi-disciplinary team actually working onthis. So I would advise for physician practices, nomatter how small or large, that you have somebodythatknowsaboutthebillingandsubmittingpayments,somebody that knows about the practicemanagement,physicians,nurses,andwellbutIthinkithastobeagroupeffort.

ArehospitalsgoingtobepartofMIPS? [BobbiBrown]They are not right now. The providers that practiceunderahospital, theywill go intoMIPS,but in somecasestheydonothavetheirowncertifiedEHR.Theyuse the EHR of the facility. So no for hospitals rightnow. Yes,hospitalswillhave to submit forprovidersjustliketheydoonPQRS.

Pleaseclarifywhatcross-cuttingis. [BobbiBrown]Cross-cuttingmeansthatameasurecanapplytoalotofdifferentspecialties.Itisnotjustsomethingthatislike only for an obstetrician or only for internalmedicine.Sothesearemeasures.Thatway,theycanget a good cross set. They try to getmeasures thatarespecialtyspecificandthenalotofthesemeasuresthatcouldbewhatyoucallmoregeneric.

[Dr.BryanOshiro]Some of the cross-cutting measures that they askedabout earlier, Bobbi, you sort of mentioned, is carecoordinationmaybeoneofthose.Theotherthingisaccess to care. Soextendinghours and so forth. Sothosearesomecross-cuttingmeasures.Soifyoucanthinkofofficepracticeandefficienciesthatgoacrossspecialties,nomatterwhattheyare,riskstratification,adjustment issues,andso forthmaybepartof thoseaswell.

WillCMSchangeinmeasuresovertime? [BobbiBrown]Ohheavens,yes,theyaregoingtochange.Myguesswouldbe, like I said, the last300pagesor200pagesofthecurrentregulations,anditisintableformat,areactuallyallthemeasuresandyoucanpickfromsixofthose. And Iexpect themtochange. Someof thosewillchangebythefinalregulation.ProbablynotalotbutIexpectthatovertheyear,theytopoutonsomemeasures. Whenever we are doing all A on givingaspirin within so many minutes of coming into theemergencyroom,thatmeasuretopsoutandtheypull

thatoutandreplaceitwithanothermeasure.

Do you think MACRA might result on a lot ofindependent physicians getting consolidated orindependent doctors first to merge, (54:11) changemanagementissuefortheeligibleclinicians?

[BobbiBrown]Igotoan independentphysician. Myprimarycare isindependentandIlovehim.WhenIgrewup,mydadownedasmalldrugstore,andheeventuallysoldthattoWalgreens. But I like independentpractice. I likesmallbusiness.Ihopethisdoesnothappenbutthereissomereadingonthewallhere.

Dr.Oshiro,anythoughtsonthat?

[Dr.BryanOshiro]Yeah. Actually, several of my friends are in primarycare and they have solo practices or two-personpracticesandtheyarejustwaitingtoretire.Theysaythat this is a very onerous condition. Some of theotheronesthatarestillalittlebityoungerarelookingfor employment models because they say that theycannotpracticeanddothebusinesssideofit.Itisjustgettingtoocomplexforthem.SoIthinkthatthatisacorrectassumption.Atleast,thatisthewaythatIamreadingthetealeaves,isthatpeoplearenotgoingtobe able to practice independently. I think theexceptionsaregoingtobe insmall ruralareaswhereyouhavelowvolumeprovidersandsoforththattheycannotgooutofbusiness. Theyneed them in thoseruralareasandsmallmarketsandsoforth.SoIthinkthat there is going to be exceptions based on thevolume issues and stuff and they are excludedanyway.Sotherewillbesomeaccommodationsmadeforthat.

[BobbiBrown]Ihadmadeacommentabout thedollaramount, thefinancial impact is tiny, so why should I care. And Ibelieve rightnow,underPQRS, I thinkCMS thatonlyabout 32 percent of the eligible providers areparticipating inthatprogram. Soagain,youcouldbepart of MIPS and just go along with like you arenormallydoing.Youwillhavetosubmitrequirementsand there is not a penalty. I have not seen anypenalties inthereyet. Eventually, it is just likePQRS.Thatwillhappen,penaltiesfornotparticipatingatallifyou did not turn in any measures. So eventually Iwouldsay thatwillhappen. It isnot there rightnowthough.

Why the regulation does not address HIPAA orcomplianceorsecurity?

[BobbiBrown]Theregulationsaysyouhavetoattesttosecurity,thatyou are doing your best to meet security

requirements.SotherewillbeanattestationinthereandIwouldassumeovertimethatthisisonethatwewillseemoreregulationon.

Again,anycommentsonthat,Dr.Oshiro?

[Dr.BryanOshiro]No, that is right. I think it is part of it. It hasincorporated into itbut it isnotamajor focusof theprogram.

[BobbiBrown]Yeah.Soyeah,theyarebringinginthemeaningfuluseandtryingtomakeitnottooonerousforpeople.

The300measurements,arethereup… [BobbiBrown]Rightnow,wedonothaveupper limits, lower limits.Again, 2017 will be the performance year. And so,what is in 2017, and they are going to try to getthroughareportbyJulyof2018andthatwillallhaveto be – we cannot take vacation. We cannot havevacation then. But we really want to look at whenthosereportscomeoutinJulyof2018,whereweare.TheyaregoingtoputsomereportsoutinJulyof2017thatwill be based on history and again probably notthat much movement in the measurements. Andprobably what you are reporting now for PQRS, youcan,likeIsaid,lookatyourownPQRSandseewhatisgoingonandthenyoucangofromthere.

WillPQRSnolongerbethestandard? [BobbiBrown]Yes, PQRS will no longer be the standard and beintegrated in theMIPS. Yes. That is thewholepointofMIPS.SoyouwilldoPQRSin2017andin2018andthenin2019,goodbye.

CanyoucompareandcontrasttheimpactofMIPSonspecialty physicians versus primary care physicians?Can you also compare and contrast the impact ofAPMSon the same? HowdoesMACRAparticipationrelatetobundles?

[Dr.BryanOshiro]Yeah.Sothatiskindofaninterestingquestionanditisunclearastowhattheimpactisgoingtobe.Sowewill have to seegoing forward. So that is somethingthatI,myself,beingasubspecialist,wearegoingtobeimpacted on that as well. So I am going to have totakea lookmorecarefullyastohowit isconstructedbut it is the overall, through the care coordinationaspectofitthatthatiswhatisgoingtolooklikeasfaras getting into our practice. But there areperformance measures for individual subspecialties.Andso,thatisgoingtobeanareaofintensefocusformepersonallyaswell.

[ChrisKeller]

Okay.Verygood.Thankyou,Dr.Oshiro,thankyou,Bobbi,foratremendouswebinarwithlotsof information. I wish we could have gone a little longer. There were still probably 35questions. And by the way, we have had an incredible attendance.We had 1,200 peopleregistered for this andwehave had a great turnout today. So thank you for everyonewhojoinedtoday.Shortlyafterthiswebinar,youwillreceiveanemailwithlinkstotherecordingofthiswebinarandthepresentationslidesandthepollquestionsummaryresults.Also,pleaselookforwardtothetranscriptnotificationwewillsendyouonceitisready.

OnbehalfofBobbiBrown,Dr.BryanOshiro,aswellastherestofushereatHealthCatalyst®,thanyouforjoiningustoday.Thiswebinarisnowconcluded.

[ENDOFTRANSCRIPT]

Making Sense of MACRA - Health CatalystMaking Sense of MACRA May 10, 2016 Making Sense of MACRA May...

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