The teleconference discusses the Medicare Access and CHIP Reauthorization Act (MACRA) and its implications for hospitalists, including eligibility requirements, payment adjustments, and reporting practices. Key topics include the Quality Payment Program (QPP), individual versus group reporting, and CMS notifications. The session aims to provide guidance and answer questions from eligible clinicians regarding participation and methods for compliance.

1. MACRA and Hospitalists:
Get Your Questions Answered
Presented By:
Liz Morgan – Senior Solutions Engineer, Iatric Systems
Cindy Paul – Senior Project Manager, Professional Service, Iatric
Systems
Technical Assistance: Amanda.Howell@iatric.com
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3. Presented By:
Liz Morgan – Senior Solutions Engineer, Iatric Systems
Cindy Paul – Senior Project Manager, Professional Service,
Iatric Systems
Date: June 6, 2017
MACRA and Hospitalists:
Get Your Questions Answered

4. Agenda
• MACRA/MIPS/QPP - Defined
• Eligibility – Who needs to Participate
• Timing – Pick Your Pace
• Program Components MIPS
• CMS Notifications
• QPP and Groups
• CMS Deadline
• How to Get Help
• Q&A

5. Poll question
Do you believe your hospitalists bill
$30,000 AND see more than 100
patients for Medicare Part B or
Observation?
a) Yes
b) No
c) Don’t Know

6. Medicare Access and CHIP
Reauthorization Act of 2015 (MACRA)
• Passed by congress April 14,2015
• Removes Sustainable Growth Rate
Methodology – SGR
• Revise the update in rates
• Establishes Quality Payment Program
(QPP)
• Final Rule issued October 14, 2016

7. Eligible Clinicians (EC)
Hospitalists Anesthesiologist Radiologists
Pathologists
Emergency
Department
Physician
Clinicians who have billed more than $30,000 in
Medicare Part B allowable charges and have more
than 100 Part B-enrolled Medicare beneficiaries

8. Pick Your Pace

9. Payment Adjustment

10. Four Categories
2017 2017 2017 2018

11. Categories and Percentage
Quality 60%
Need to report 6
Improvement Activities 15%
Need to report 4
Advancing Care Information 25%
Cost 2018
85%
15%

12. CMS Notification
• Letters went out to each Eligible Clinician
• Mailed to TIN
• Late April or Early May
• Designated if they were eligible

13. Poll question
Have you received a letter from CMS
stating that you are required to
submit for MIPS?
a) Yes
b) No
c) Don’t Know

14. QPP and Groups

15. Reporting as Individual
• Individual National Provider Identifier
• Tied to single Tax Identification Number
(TIN)
• Individual data for each MIPS Category
• Payment adjustment based on YOUR
performance

16. Reporting as a Group
Group Defined:
Set of eligible clinicians, identified by their
National Provider Identifier (NPI) sharing a
common Tax Identification Number (TIN), no
matter the specialty or practice site.

17. Group
• One TIN
• Regardless of specialty or practice site
• Aggregated group level data sent for each
MIPS Category
• In-Hospital physicians in group – no need to
report on Advancing Care Information

18. Digesting CMS Information
The hospital-based determination is done at the
individual national provider identifier (NPI) level. If an
eligible clinician is determined to be hospital-based, that
status will apply to all NPI/ tax identification number
(TIN) combinations for the clinician. If an individual
eligible clinician is hospital-based, we will automatically
reweight the Advancing Care Information (ACI)
performance category. If the eligible clinician is part of a
group, the group has the option to include or exclude
ACI data for the hospital-based clinician(s). If the entire
group is hospital-based, the group's ACI category will be
reweighted if the group does not submit any ACI data.
The group, despite being entirely hospital-based, would
have the option to include, or not include their data in
the group data that is submitted to CMS, but their
payment will be adjusted based on the group's MIPS final
score.
If an eligible clinician is determined to be hospital-based,
that status will apply to all NPI/ tax identification number
(TIN) combinations for the clinician. If an individual
eligible clinician is hospital-based, we will automatically
reweight the Advancing Care Information (ACI)
performance category. If the eligible clinician is part of a
group, the group has the option to include or exclude
ACI data for the hospital-based clinician(s). If the entire
group is hospital-based, the group's ACI category will be
reweighted if the group does not submit any ACI data.
The group, despite being entirely
hospital-based, would have the option to
include, or not include their data in the
group data that is submitted to CMS, but
their payment will be adjusted based on
the group's MIPS final score.

19. Groups, Quality, and the
Physician Compare Conundrum

20. Groups and Physician Compare
• PQRS = MIPS Quality
• Selected Measures apply to all physicians
• Tax Identification Number
• Data Aggregation

21. Questions for Your Consideration
• Do you have one TIN?
• Does this structure have the ability to satisfy
all your physician types?
• If not, how could your hospital benefit?
• Does it really matter if a physician has no
data on Physician Compare?

22. Things to Think About
• This is a QUALITY program – how will the group
fare?
• Hospital Contract?
• What is your plan? October 2nd is the last day to
get 90 days of information

23. Deadline:
For groups to use the CMS Web Interface, you
must register by June 30, 2017

24. Get Help Defining Your Plan
q Identify which providers or groups are MIPS eligible
within your organization
q Assist with Pick Your Pace
q Assist with identifying Quality Measures
q Assist with identifying Improvement Activities
q Gap Analysis
q Action Plan

25. What Questions Do You Have?

26. We Can Help!
Liz Morgan
Senior Solutions Engineer – Iatric Systems
Phone: (978) 674-8317
E-mail: Liz.Morgan@iatric.com
Connect with me on LinkedIn: Liz Morgan
Cindy Paul
Senior Project Manager, Iatric Systems
Phone: (978) 674-5927
Email: Cindy.Paul@iatric.com
Connect with me on LinkedIn: Cindy Paul
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