The MACRA final rule was released in October of this year after a six-month CMS tour of the country. In their tour they spoke with physicians nationwide about their ability to participate in this new Quality Payment Program. After much…ah hem…feedback, CMS released the final rule with several modifications based upon their listening tour.

1. MACRA

2. Medicare Access and
CHIP Reauthorization Act
MACRA

3. THREE MAJOR CHANGES
Ending 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

4. These changes
create the:
QUALITY
PAYMENT
PROGRAM

5. TWO TRACKS FOR CLINICIANS
TO CHOOSE FOR REPORTING
MIPS
Merit-based
Incentive System APMs
Alternative
Payment
Models

6. MIPS

7. 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

8. Clinicians receive a composite score based on their
performance in these 4 areas:
MIPS
= MIPS Composite Performance Score
Quality
Improvement
Activities
Advancing
Care
Information
Cost*+ + +
*Starts in 2018

9. MIPS Performance Categories
60%
Quality
Replaces the Physician Quality
Reporting System (PQRS)

10. MIPS Performance Categories
25%
Improvement
Activities
New Category

11. MIPS Performance Categories
15%
Advancing Care
Information
Replaces the Medicare EHR
Incentive Program (Meaningful Use)

12. MIPS Performance Categories
0%
Cost
Replaces the Value-Based Modifier
(STARTS IN 2018)

13. COMPOSITE PERFORMANCE
SCORE BREAKDOWN:
Quality
Improvement Activities
Advancing Care Information
Cost
60%
25%
15%

14. APMs

15. An APM is a payment
approach that provides added
incentives to clinicians to
provide high-quality,
cost-efficient care.
Most providers who
participate in APMs will
also be subject to MIPS.
APMs

16. 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
APMs

17. 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

18. REPORTING
OPTIONS

19. Don’t Participate
Don’t send any 2017 data to Medicare.
Receive a -4% payment adjustment.

20. Option 1
Test
the Quality
Reporting Program

21. Option 1
Submit Something
Submit a minimum amount of 2017 data to Medicare.
For example, one quality measure or one improvement activity.

22. Option 1
If completed,
you’ll avoid a
negative adjustment.

23. Participate
for part of the
calendar year
Option 2

24. Option 2
Submit 90 days of 2017 data
to Medicare.
• You can start later than January 1, 2017
• Select from the list of quality measures and
improvement activities in MIPS

25. Option 2
If completed,
you could still qualify for a
small positive payment
adjustment.

26. Option 3
Participate
for the full
calendar year

27. Option 3
Submit a full year of 2017
data to Medicare.
• First performance period begins January 1, 2017

28. Option 3
If completed,
you could qualify for a
“modest positive payment
adjustment.”

29. Option 4 Option 4
Participate
in an Advanced Alternative
Payment Model in 2017

30. Option 4
Requirements to participate in Advanced APM
Medicare payments
through Advanced APM
Medicare patients
through Advanced APM
25% 20%

31. Option 4
If qualified,
you will receive a +5%
incentive payment in 2019.

32. To learn more about MACRA as
it progresses check back with
Medisolv at Medisolv.com
www.medisolv.com | (844) 633-4675 | info@medisolv.com