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The 7 Best Ways to Prepare for MACRA Today

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The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law in 2015, with major impacts starting in 2019. MACRA attempts to prioritize quality over quantity by letting providers choose between two value-based payment tracks: MIPs and APMs. Providers won’t have to choose until 2019; until then, they will receive a .5 percent annual increase.

The industry is conflicted about MACRA. On the one hand, many believe it is part of the overall shift to value-based healthcare. On the other hand, many say the administrative burden will overwhelm providers. Another area of MACRA controversy has to do with meaningful use which, contrary to what the CMS Acting Administrator said in 2016, isn’t going away with the introduction of MACRA.

Although it seems a ways away, MACRA’s base year will likely be 2017. Armed with the seven best ways to start preparing for MACRA today, and an EDW that provides clinicians with the self-service tools to monitor their performance, health systems can be ready to tackle MACRA when it finally goes into effect.

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The 7 Best Ways to Prepare for MACRA Today

  1. 1. The 7 Best Ways to Prepare for MACRA Today ̶ Bobbi Brown
  2. 2. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The 7 Best Ways to Prepare for MACRA Today What does the Medicare Access and CHIP Reauthorization Act (MACRA), signed into law in 2015, mean for healthcare organizations and providers? At HIMSS 2016, the CMS Center for Clinical Standards and Quality Director, Kate Goodrich, MD, stated MACRA’s goal: “…to have a single, unified program with flexibility. The new Merit-Based Incentive Payment System (MIPS) will offer that flexibility and not be a one-size fits all program. The new rule will reimburse physicians based on four factors.” Hospitals are not impacted by this regulation.
  3. 3. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The 7 Best Ways to Prepare for MACRA Today The proposed regulations published in April 2016 provide more detail on the quality measures and scoring. MACRA’s base year will be 2017—and 2017 is just around the corner. The first payment year will be 2019. This presentation provides an overview of MACRA and guidance about what health systems should do to prepare for MACRA now.
  4. 4. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. MACRA Overview MACRA permanently replaces the unsustainable Sustainable Growth Rate (SGR) formula (created in 1997 to restrict growth in Medicare Part B spending) with a system that attempts to prioritize quality over quantity. It also replaces Medicare’s physician quality reporting programs with a Merit- Based Incentive Payment System (MIPS).
  5. 5. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. MACRA Overview Several programs such as Accountable Care Organizations (ACOs), bundled payments, and various value-based models exist for hospitals and eligible professionals. These programs will continue and their incentives/penalties are not impacted by MACRA.
  6. 6. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. MACRA Overview Under MACRA, providers will receive a .5 percent annual increase until 2019, at which point they can choose between two value-based payment tracks: MIPS or Alterative Payment Models (APMs). Meaningful use will be moved under MACRA in both tracks.
  7. 7. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Starting in 2019, providers can choose between MIPS and APMs: MIPS will be the default system, and consolidates the existing Meaningful Use, Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VBM) programs. Physicians that choose this track face payment increases and or reductions based on performance.
  8. 8. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs In the first year of payment, 2019, there is potential for a maximum plus or minus 4% or payments could also have no change or remain neutral. A bonus (not to exceed 10%) for exceptional performance is part of this program for the first five years. An overall MIPS score will be calculated according to performance in four measures (weighted by performance, with potential changes in weight by year):
  9. 9. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Quality (50 percent) Chose six measures to submit. Example of outcome measure: 20/40 or Better Visual Acuity within 90 Days Following Cataract Surgery 1
  10. 10. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Cost (Resource use) (10 percent) Calculated by CMS to compare resources used to treat similar care episodes and clinical condition groups across practices. 2
  11. 11. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Advancing care information (Meaningful use) (25 percent) Continued focus on interoperability and security Example: Electronic prescribing 3
  12. 12. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Clinical practice improvement activities (15 percent) General categories include patient access, care coordination. Specifics due later. 4
  13. 13. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs APMs The APMs track reimburses Medicare providers based on value of services rather than service volume. Providers meeting the criteria for this track cannot move to the MIPS track. Physicians receiving a significant portion of their payments through eligible APMs can be exempt from MIPS—and they receive a lump sum payment of 5 percent of covered services. By 2018, CMS wants 90 percent of payments tied to quality, with 50 percent under APMs.
  14. 14. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs APMs By 2018, CMS wants 90 percent of payments tied to quality, with 50 percent under APMs. The regulations provided more guidance on this track. Criteria include: The advanced APM must require use of certified EHR technology. Payment must be based on quality measures. There also needs to be financial risk or a medical home that meets certain criteria. > > >
  15. 15. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Two Value-Based Payment Tracks: MIPS and APMs Generally, most providers will not meet the criteria for this track, however some organizations are automatically qualified: Comprehensive ESRD Care Model (large dialysis organization): 12 participants Medicare Shared Savings Program— Track 2 and Track 3: 24 participants Next Generation ACO Model: 21 participants Comprehensive Primary Care Plus (CPC+): Currently regional with payers, available in 2017 Oncology Care Model Two-Sided Risk Arrangement (available in 2018) > > > > >
  16. 16. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Meaningful Use Is Still Here In January, 2016, the CMS Acting Administrator, Andy Slavitt, tweeted about the end of meaningful use: In 2016, MU [meaningful use] as it has existed—with MACRA—will now be effectively over and replaced with something better.” But Slavitt’s tweet was followed up with a speech and blog post in which he softened his declaration: In 2016, MU [meaningful use] as it has existed—with MACRA—will now be effectively over and replaced with something better.”
  17. 17. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Meaningful Use Is Still Here Most recently, at the 2016 HIMSS, CMS officials stated that physicians can expect meaningful use to continue to be required. Indeed, MACRA will require the continuation of meaningful use for Medicare-eligible professionals, but the incentive program can be modified to achieve the results CMS wants.
  18. 18. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Meaningful Use Is Still Here CMS EHR incentive programs have paid out $31.5 billion between January, 2011 and January, 2016. The Eligible Professionals (EP) program received $12.6 billion for approximately 465,000 unique providers. Nothing has changed in 2016. In January, 2016, more than 200,000 eligible professionals saw a decrease in Medicare payments because they failed to meet meaningful use standards in 2014. Meaningful use isn’t going away.
  19. 19. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Overcoming MACRA’s Admin Burden with an EDW The biggest challenge MACRA brings to healthcare organizations and, in particular, physicians, is administrative burden. In particular, compiling quality metrics. A survey conducted in March, 2016 by Weill Cornell Medical College and the Medical Group Management Association (MGMA) found that physicians spend an average of 15.1 hours every week processing quality metrics.
  20. 20. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Overcoming MACRA’s Admin Burden with an EDW The time physicians spend processing quality metrics translates to an average cost of $40,069 per physician, per year. These figures emphasize the analytics burden that needs to offset by clearly defined benefits. Implementing an enterprise data warehouse (EDW) and providing physicians with self-service tools to analyze their performance will help providers and systems navigate the adminis- trative burden introduced by MACRA.
  21. 21. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Although 2019 seems far away, health systems need to start thinking about MACRA now. For the most part, health systems and physicians haven’t realized the impact of this shift; nor have they determined the right strategies. There are several things health systems can do to start preparing for MACRA now:
  22. 22. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Outline a strategy for tackling MACRA by Q4 2016. 1
  23. 23. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Educate providers and encourage discussion about the new regulation. 2
  24. 24. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Attend professional society meetings and use the resources they offer.* 3 *(Physician groups like the American Medical Association (AMA) and American Academy of Family Physicians (AAFP) are active in their efforts to train and advocate for physicians on MACRA. The American Hospital Association (AHA) provides online resources, including a webinar, to help systems prepare for MACRA.)
  25. 25. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Identify health system thought leaders and discuss APMs (ACOs, etc.). 4
  26. 26. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Take a look at your quality measures and identify high-performing areas. 5
  27. 27. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Review your CMS Quality Resource and Use Report (QRUR). 6
  28. 28. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today If you did not report for PQRS or meaningful use, then evaluate the penalties and your readiness for MACRA. 7
  29. 29. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. The Seven Best Ways to Prepare for MACRA Today Although we’ll know more about MACRA in the coming months, 2017 will most likely be MACRA’s base year, so the best time to start preparing for MACRA is today. We’ll provide a follow-up to this blog as new details about MACRA are released.
  30. 30. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. For more information: “This book is a fantastic piece of work” – Robert Lindeman MD, FAAP, Chief Physician Quality Officer
  31. 31. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. More about this topic Link to original article for a more in-depth discussion. The 7 Best Ways to Prepare for MACRA Today From Meaningful Use to Meaningful Analytics Brian Ahier, President of Advanced Health Information Exchange Resources, LLC 6 Surprising Benefits of Healthcare Data Warehouses: Getting More Than You Expected Mike Doyle, Sales, VP Why You Need to Understand Value-Based Reimbursement and How to Survive It Bobbi Brown, Vice President of Financial Engagement Value-Based Purchasing: Why Your Timeline Just Got Shorter Bobbi Brown, Vice President of Financial Engagement The Key to Transitioning from Fee-for-Service to Value-Based Reimbursement Bobbi Brown, Vice President of Financial Engagement; Jared Crapo, Sales, VP
  32. 32. © 2016 Health Catalyst Proprietary. Feel free to share but we would appreciate a Health Catalyst citation. Bobbi Brown is the Vice President of Financial Engagement for Health Catalyst. Ms. Brown started her healthcare career at Intermountain Healthcare supporting clinical integration efforts before moving to Sutter Health and, later, Kaiser Permanente, where she served as Vice President of Financial Planning and Performance. Ms. Brown holds an MBA from the Thunderbird School of Global Management as well as a BA in Spanish and Education from Misericordia University. She regularly writes and teaches on finance- related healthcare topics. Other Clinical Quality Improvement Resources Click to read additional information at www.healthcatalyst.com

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