MACRA has been the hot topic since the proposed rule was announced in May. Feedback is still being collected, but we have seen the proposal and many responses from leading industry organizations. Find out what we know now and what we expect see in the coming months. In this free webinar, renowned blogger John Lynn will look at: 1. Some of the components of MACRA, including MIPS 2. What they mean by Alternative Practice Models 3. The change from Meaningful Use to Advancing Care Information 4. How these changes may impact smaller practices Don’t miss this chance to get the latest update on MACRA to understand how it may impact you starting in 2017.

1. webinar
MACRA
What’s In Store for Independent Practices
Presented by John Lynn July 13, 2016

2. @GoKareo
Agenda
2
Agenda
2
• Welcome & Introductions
• MACRA
• How Kareo Can Help
• Your Questions

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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
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Agenda
5
• Welcome & Introductions
• MACRA
• How Kareo Can Help
• Your Questions

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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 Program
Streamlines 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)

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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 Organization
Ask:
• Are You a Qualified APM Participant (QP)?
Only Advanced APMs (QPs) Are Excluded from MIPS

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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)

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MIPS Details
Worth Noting:
• Medicaid EHR Incentive Program will Continue
• Medicare EHR Incentive Program for Hospitals Will Continue
Immediate 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 Replacement
No Data Submission Required
• Calculated Based on Claims
Changes:
• 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) Replacement
Changes:
• 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)

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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 Program
Accommodations for Small Practice Reporting for:
• Quality Category
• Cost Category
• Clinical Practice Improvement Category

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MACRA Comment Period
134 Physician Events – 60,000 Participants
3,710 Formal Comments Received
General 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

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Medicare Fee Schedule Changes

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How Do You Fit Into MACRA?

31. @GoKareo
Agenda
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Agenda
31
• Welcome & Introductions
• MACRA
• How Kareo Can Help
• Your Questions

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Awards and Rankings
Growth awards
The speed at which
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moving to Kareo and
referring it to other
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Best places to work
Happy, engaged
employees stay longer,
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offer better customer
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3rd party recognition,
driven by direct
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equals trust and
credibility

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Kareo Platform
Kareo Billing
• Centralized A/R Management
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Kareo Platform
Kareo Clinical
• Comprehensive dashboard
• Simple charting
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• Convenient eLabs
• Specialty templates
• Electronic Superbill
• Integrated Patient Portal
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Kareo Platform
Kareo Managed Billing
• Dedicated team of specialists
• Simple scheduling/calendar
• Charge Capture (web/mobile)
• Nationwide Billing Rules Engine
• Claims tracking
• Billing Tasks
• Billing Analytics

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Kareo Platform
Kareo Marketing
• Marketing and front office
automation
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• Online appt. scheduling
• Email, text & voice recording
appt. reminders
• Post visit patient reviews
• Practice analytics for ROI
• Patient communications

37. @GoKareo
Agenda
37
Agenda
37
• Welcome & Introductions
• MACRA
• How Kareo Can Help
• Your Questions

38. Connect with Kareo
Stop by and say hi!
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