MACRA consolidates existing Medicare quality programs and establishes two pathways for physicians: MIPS and APMs. MIPS assesses performance in four categories (quality, cost, improvement activities, advancing care information) and adjusts payments up or down based on a composite score. It allows physicians to ease into reporting over multiple years. APMs provide an alternative for physicians meeting thresholds in qualifying models, exempting them from MIPS and providing bonus payments through 2024. MACRA aims to shift Medicare payments from volume to value over time through 2026.
On May 23, Conifer Health Solutions hosted a lecture at the ACHE Fellows Seminar in San Antonio, TX. The lecture, “Planning for Success with Clinical Integration,” focused on the steps associated with building a clinically integrated network; the power of strategic alignment with partners in the care community; and sustainable governance and incentive structures for the clinically integrated network.
On May 23, Conifer Health Solutions hosted a lecture at the ACHE Fellows Seminar in San Antonio, TX. The lecture, “Planning for Success with Clinical Integration,” focused on the steps associated with building a clinically integrated network; the power of strategic alignment with partners in the care community; and sustainable governance and incentive structures for the clinically integrated network.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The transformation towards more integrated and accountable healthcare delivery systems is aligning physicians, outpatient care, hospitals and ultimately payers in unprecedented numbers. Yet creating a successful clinically integrated network can be a daunting and complicated undertaking.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
Conifer Health President of Value-Based Care, Megan North and Gayle Capozzalo, FACHE Executive Vice President/Chief Strategy Officer, Yale New Haven Health System (YNHHS), co-presented at the the Becker’s Hospital Review 7th Annual Meeting in Chicago. North and Capozzalo shared “A Seven-Step Approach to a Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
Monthly series covering key subjects regarding healthcare business in the USA. This seminar covers: Affordable Care Act section 1557, HIPAA Security, Medicare Payment models and Chronic conditions.
Brief presentation regarding key topics in the USA healthcare industry. Some of the basic topics include: MACRA, ICD 10, Meaningful Use and a very brief comment about diabetes as a chronic condition.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
Since the launch of the Marketplaces and Medicaid expansion, one out of every 20 Americans has been added to the Medicaid roll. More than 51 million Americans receive physical health benefits from a private Medicaid health plan (or 70% of all beneficiaries) and as of Q3 2015, 41 states had some form of private managed Medicaid. Along with the rapid expansion of Medicaid, comes the push for managed care plans to adopt value-based care approaches that tie provider reimbursement to quality measures and better outcomes. This presentation gives physicians crucial details about Medicaid and CHIP Managed Care Proposed Rule CMS 2390-P, and the five factors for value-based payment success in the era of Managed Medicaid.”
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
Physician Payment Reforms: The Future of MIPS and APMs – Value-Based Payments...Epstein Becker Green
Epstein Becker Green Webinar with Attorney Lesley Yeung - Value-Based Payments Crash Course Webinar Series - May 16, 2016.
Topics include:
* An overview of the physician payment reforms included in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”)
* A summary of the Merit-Based Incentive Payment System (“MIPS”) and Alternative Payment Models (“APMs”) Proposed Rule (publication is expected in the spring of 2016)
* Opportunities for provider engagement with the Centers for Medicare & Medicaid Services to shape physician payment reform efforts
http://www.ebglaw.com/events/physician-payment-reforms-the-future-of-mips-and-apms-value-based-payments-crash-course-webinar-series/
These materials have been provided for informational purposes only and are not intended and should not be construed to constitute legal advice. The content of these materials is copyrighted to Epstein Becker & Green, P.C. ATTORNEY ADVERTISING.
The transformation towards more integrated and accountable healthcare delivery systems is aligning physicians, outpatient care, hospitals and ultimately payers in unprecedented numbers. Yet creating a successful clinically integrated network can be a daunting and complicated undertaking.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
Conifer Health President of Value-Based Care, Megan North and Gayle Capozzalo, FACHE Executive Vice President/Chief Strategy Officer, Yale New Haven Health System (YNHHS), co-presented at the the Becker’s Hospital Review 7th Annual Meeting in Chicago. North and Capozzalo shared “A Seven-Step Approach to a Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
In January 2013, Catholic Health Initiatives began a multi-phase journey to develop a population health management solution across all of its regions. This presentation will describe the strategies the health system pursued for: creating a clinically integrated network as a first step in managing the health of populations and integrating care across the patient experience; aligning hospitals and physician groups to create successful clinical models; creating a data platform to share clinical measures and benchmarks; and ultimately becoming a risk-bearing shared savings ACO. Participants will hear real-world examples of best practices for how to meet FTC regulations, create an effective governance structure to manage performance, and align financial incentives. Learn how one of the nation's largest hospital systems developed a system-wide population health management solution in order to achieve the necessary transformation from fee-for-service to fee-for-value.
Monthly series covering key subjects regarding healthcare business in the USA. This seminar covers: Affordable Care Act section 1557, HIPAA Security, Medicare Payment models and Chronic conditions.
Brief presentation regarding key topics in the USA healthcare industry. Some of the basic topics include: MACRA, ICD 10, Meaningful Use and a very brief comment about diabetes as a chronic condition.
Partnering for Population Health: Strategies to Promote Collaboration Among t...Conifer Health Solutions
A patient-centered approach to care delivery will bring the best health outcomes for individuals, as well as the community. While it is clear that effective population health management is integral to better health, providers can no longer be the sole proprietors of data and information. Improving a population’s health will depend on strong alliances with community stakeholders that generally have not experienced a strong history of collaboration. In the new healthcare landscape, providers, payers and employers must partner to reduce cost, boost quality and improve the health of their shared populations. These new partnerships may start with a few glitches. However a strategic plan, clear objectives and an engaged, informed patient will smooth the path to improved outcomes.
The Medicare Aaccess and CHIP Reauthorization Act of 2015 establishes two Quality Payment Programs to transition the U.S. Healthcare System from a Fee-For-Service reimbursement methodology to a Fee-For-Value model. MACRA fundamentally adjusts the Medicare Fee Schedule, forcing healthcare providers to utilize HIT, population health management, and care coordination to receive financial rewards.
Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse...PYA, P.C.
PYA Senior Manager Chris Beckham co-presented “Modern Physician-Hospital Affiliations in an Era of Increased Fraud and Abuse Scrutiny” with Ross Burris of Polsinelli at the American Health Lawyer Association’s (AHLA) Physicians and Hospitals Law Institute, February 8-10, 2016.
Achieving population health management through more coordinated care is becoming essential as healthcare organizations move away from fee-for-service models and begin operating in the new value-based care environment. One path to succeeding in this new environment and achieving more coordinated care is through formation of a clinically integrated network.
Yale New Haven Health System (YNHHS), a nonprofit academic medical center, is following a seven-phase plan to achieve a regional, clinically integrated network with the ultimate goal of population health management.
On March 16, 2016, President of Value-Based Care, Megan North and Amanda Skinner, Executive Director of Clinical Integration and Population Health for Yale New Haven Health System (YNHHS), co-presented at the 2016 American College of Healthcare Executives’ Annual Congress on Healthcare Leadership (ACHE Congress). North and Skinner shared “A Step-by-Step Approach to A Clinically Integrated Network,” to provide insights into each step of the clinical integration road map.
Due to popular demand, the Comprehensive Primary Care Plus (CPC+) team hosted a repeat of the webinar that was originally held on Thursday, April 21, 2016. During this webinar Model team members provided an overview of the model specifically for health IT vendors.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
Big Data: Implications of Data Mining for Employed Physician Compliance Manag...PYA, P.C.
PYA Consulting Manager Kristen Lilly presented “Big Data: Implications of Data Mining for Employed Physician Compliance Management” during a webinar for the Georgia chapter of the Healthcare Financial Management Association (Georgia HFMA), March 31, 2016.
The presentation explored:
Public relations and litigation risk from the public dissemination of data by the government.
Internal use of broad spectrum analytics in employed physician compliance management.
Determination of risk tolerance and the customization of “outside the box” analytics.
Benchmarking, monitoring, and defining physician-focused risk area reviews.
Since the launch of the Marketplaces and Medicaid expansion, one out of every 20 Americans has been added to the Medicaid roll. More than 51 million Americans receive physical health benefits from a private Medicaid health plan (or 70% of all beneficiaries) and as of Q3 2015, 41 states had some form of private managed Medicaid. Along with the rapid expansion of Medicaid, comes the push for managed care plans to adopt value-based care approaches that tie provider reimbursement to quality measures and better outcomes. This presentation gives physicians crucial details about Medicaid and CHIP Managed Care Proposed Rule CMS 2390-P, and the five factors for value-based payment success in the era of Managed Medicaid.”
Presentation Explores Many Contexts of Community BenefitPYA, P.C.
PYA Principal David McMillan gets to the bottom of the definition of community benefit in “Community Benefit: One Term, Many Contexts,” a presentation given at the 2013 AICPA Healthcare Industry Conference.
PYA Principal J. Michael Keegan, MD, recently presented “Pacing Volume-to-Value Transition” and “The ROI of Avoiding Antibiotic Overuse” at the AlaHA Annual Meeting, June 8-11, 2016. The presentation focused on the importance of antibiotic stewardship programs (ASP) for population health. The presentation explained:
Why the Centers for Medicare & Medicaid Services is proposing a requirement that hospitals implement ASPs to stem the rise of resistant bacteria.
Why PYA is invested in offering hospitals a proven program for improving patient safety while saving costs.
What constitutes a successful ASP.
Riding the Rapids of Payment Reform: Downstream Effects of Quality Reporting ...Bill Presley
In this presentation, we highlighted how quality measurement programs impact reimbursement affecting your revenue. The revenue at risk in your organization. We focused on quality programs like Value-Based Purchasing (VBP), Merit-Based Incentive Program (MIPS) and Alternative Payment Models (APM) and their impact on Part A and Part B reimbursements.
It’s no surprise that reimbursement tied to quality performance is quickly becoming a reality for hospitals and physicians. CMS’ aggressive goals aimed at increasing the percentage of Medicare payments associated with quality versus quantity can be achieved through such programs as Value-based Purchasing and MACRA. This session will cover scoring methodologies, reporting requirements, reimbursement impact, infrastructure (and other resource needs), EMR tools and tactics, and workflow modifications.
Regulatory Outlook: Knock MACRA Out of the ParkKareo
Review the latest changes to the regulatory landscape, including HIPAA, MACRA, and the NC HIE. Learn how these changes impact your clients and your business.
Performance and Reimbursement under MIPS for OrthopedicsWellbe
The 2015 MACRA legislation fundamentally changed the way in which providers are paid for their services. It also provides some relief from the “all or nothing” approach used by Meaningful Use.
This session, a review of the Final Rule published on Oct 14, 2016, conveys a practical approach to maximizing reimbursement under MIPS while reducing burden on clinical staff.
After this session, attendees will have a firm grasp of:
– the major components of the Quality Payment Program
– operational strategies for measure selection
– orthopedic-specific quality measures
About the Speaker:
karenclarkKaren R. Clark is chief information officer for OrthoTennessee, where she has worked since 1998. In that role, she serves on national committees for the Healthcare Information Management Systems Society (HIMSS.) A HIMSS Fellow and Certified Professional in Healthcare Information and Management Systems, her current HIMSS committee is the HIT User Experience, which focuses on clinician experience with health information technology.
She has spoken at the AAOE, AAOS and OrthoForum conferences on both information security and the 2015 MACRA legislation, specifically on the Merit Based Incentive Payment System (MIPS.). She is a member of the College of Healthcare Information Management Executives (CHIME) as well as the CIO/CMIO Council with the American Medical Group Association.
After graduating from American University with a degree in marketing in 1979, she joined Brooks Brothers in New York, where she was a buyer. She earned her MBA in finance from Fordham University in 1984. She moved to Knoxville in 1988 and joined Watson’s as director of planning and distribution when her husband, Brooks, was recruited from Sports Illustrated to Whittle Communications. They have two adult daughters, Isabel, and Olivia.
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.
Medicare Access and Chip Reauthorization Act (MACRA) is the law that changes how Providers are to be reimbursed. One of the key characteristics is that it rewards Providers based on value and not volume.
2016 MIPS Final Rule: What you need to know NOWBen Quirk
Find out why you need to pay attention to this Final Rule and what adjustments you need to make to ensure you end up on the winning side of MIPS. It's a complicated program, and results from the Final Rule don't make it any easier.
How to Earn Your 9% MIPS Incentive Despite 2020 ChallengesKareo
In this webinar, Sr. Training Specialist, Marina Verdara, will provide you with the information and tools you need to ensure that you or your billing clients’ practices avoid receiving monetary penalties related to MIPS.
The CMS Innovation Center hosted a special webinar featuring Dr. Patrick Conway, CMS Deputy Administrator for Innovation and Quality and CMS Chief Medical Officer, on Monday, November 10, 2014 from 10:30am – 11:30 am ET. Dr. Conway will provided an update about the work of the CMS Innovation Center and the models being tested to improve better care for patients, better health for our communities, and lower costs through improvement for our health care system. Opportunities for questions were provided.
- - -
CMS Innovation Center
http://innovation.cms.gov
We accept comments in the spirit of our comment policy:
http://newmedia.hhs.gov/standards/comment_policy.html
CMS Privacy Policy
http://cms.gov/About-CMS/Agency-Information/Aboutwebsite/Privacy-Policy.html
The Guidebook to Medicare Access and CHIP Reauthorization Act of 2015 dispels MACRA myths and puts you in the know with easy-to-follow guidance. Interpret MACRA changes with step-by-step advice to understand and master MACRA’s final rule.
Setting Your Business Up for MIPS Success in 2019Kareo
In this webinar, Sr. Training Specialist, Marina Verdara, will provide you with the information and tools you need to ensure that your business avoids receiving penalties related to MACRA.
Marina will:
-Provide an in-depth analysis of MACRA, including APM and MIPS
-Review the four MIPS reporting categories and how your business can meet each of their individual requirements
-Recommend industry best practices so both independent medical practices and billing companies can avoid penalties in 2019
Mastering MACRA: A Beginner’s Guide to New Reimbursement ModelsCureMD
MACRA is 2 years of work, signed into law in April 2015
Extends the Children’s Health Insurance Program (CHIP) for two more years
Requires Medicare to move away from SSN based Medicare ID numbers
Includes new funding for development and testing of performance measures
Enables new programs and requirements for data sharing
Establishes new federal advisory groups.
(Click the download button for a high-resolution view)
MACRA is quickly approaching year 2. CMS recently released their 2018 Proposed Rule, and there are some significant changes everyone should be aware of.
Rather than wading through the 1,058 pages of the Proposed Rule, join CareOptimize for a look at the most important takeaways.
In less than 30 minutes, you'll learn:
Are any of your clinicians now exempt?
What is a Virtual Group, and will it save you money?
Are your practice's priorities aligned with the newly weighted categories?
How can the Proposed Rule increase your 2018 bonus?
In order to best prepare our clients for CMS' transition from Fee-For-Service to Fee-For-Value physician reimbursement, we have prepared a summary of the Merit Incentive-Based Payment System (MIPS). The MIPS program will consolidate PQRS, Meaningful Use, and the Value-Based Modifier into a single reporting program in which CMS affecting ≈95% of physicians beginning in 2017.
CRISPR-Cas9, a revolutionary gene-editing tool, holds immense potential to reshape medicine, agriculture, and our understanding of life. But like any powerful tool, it comes with ethical considerations.
Unveiling CRISPR: This naturally occurring bacterial defense system (crRNA & Cas9 protein) fights viruses. Scientists repurposed it for precise gene editing (correction, deletion, insertion) by targeting specific DNA sequences.
The Promise: CRISPR offers exciting possibilities:
Gene Therapy: Correcting genetic diseases like cystic fibrosis.
Agriculture: Engineering crops resistant to pests and harsh environments.
Research: Studying gene function to unlock new knowledge.
The Peril: Ethical concerns demand attention:
Off-target Effects: Unintended DNA edits can have unforeseen consequences.
Eugenics: Misusing CRISPR for designer babies raises social and ethical questions.
Equity: High costs could limit access to this potentially life-saving technology.
The Path Forward: Responsible development is crucial:
International Collaboration: Clear guidelines are needed for research and human trials.
Public Education: Open discussions ensure informed decisions about CRISPR.
Prioritize Safety and Ethics: Safety and ethical principles must be paramount.
CRISPR offers a powerful tool for a better future, but responsible development and addressing ethical concerns are essential. By prioritizing safety, fostering open dialogue, and ensuring equitable access, we can harness CRISPR's power for the benefit of all. (2998 characters)
One of the most developed cities of India, the city of Chennai is the capital of Tamilnadu and many people from different parts of India come here to earn their bread and butter. Being a metropolitan, the city is filled with towering building and beaches but the sad part as with almost every Indian city
We understand the unique challenges pickleball players face and are committed to helping you stay healthy and active. In this presentation, we’ll explore the three most common pickleball injuries and provide strategies for prevention and treatment.
R3 Stem Cells and Kidney Repair A New Horizon in Nephrology.pptxR3 Stem Cell
R3 Stem Cells and Kidney Repair: A New Horizon in Nephrology" explores groundbreaking advancements in the use of R3 stem cells for kidney disease treatment. This insightful piece delves into the potential of these cells to regenerate damaged kidney tissue, offering new hope for patients and reshaping the future of nephrology.
Welcome to Secret Tantric, London’s finest VIP Massage agency. Since we first opened our doors, we have provided the ultimate erotic massage experience to innumerable clients, each one searching for the very best sensual massage in London. We come by this reputation honestly with a dynamic team of the city’s most beautiful masseuses.
The dimensions of healthcare quality refer to various attributes or aspects that define the standard of healthcare services. These dimensions are used to evaluate, measure, and improve the quality of care provided to patients. A comprehensive understanding of these dimensions ensures that healthcare systems can address various aspects of patient care effectively and holistically. Dimensions of Healthcare Quality and Performance of care include the following; Appropriateness, Availability, Competence, Continuity, Effectiveness, Efficiency, Efficacy, Prevention, Respect and Care, Safety as well as Timeliness.
4. What Does MACRA Do?
• Consolidates quality programs
Merit-Based Incentive Payment
System (MIPS)
• Potential for bonus payment for participation
Advanced Alternative Payment
Models (AAPM)
4
7. MIPS Exemptions
7
• Year 1 Medicare
• Eligible Advance Alternative Payment
Model with Bonus
• Below the Low Volume Threshold
• 2017: < $30,000 Medicare Part B
allowed charges; or cares for < 100
Medicare beneficiaries
• 2018: < $90,000 Medicare Part B allowed
charges; or < 200 Medicare beneficiaries
9. MIPS Highlights
Consolidates existing quality and value programs
• Adds a category for Improvement Activities
Establishes a Final Score
• Weighted scoring by category
Provides opportunity for payment adjustments
• Both positive and negative
9
13. Individual vs. Group
• If you choose to report as a group, all
performance categories must be reported as
a group
• Groups will be scored as a group and will
receive one MIPS score
• Groups must report the same measures for
all ECs
13
14. Quality Measures
• Must report on measures
• May report more; only the highest scores will be used
to calculate the quality score
• Most measures need a 20 patient case minimum
• One must be an measure
– Controlling high blood pressure; A1C Poor Control
16. Advancing Care Information
• ACI replaced Meaningful Use
• Must use certified EHR technology (CEHRT) to report for
the ACI performance category
• In 2017 and 2018, the CEHRT may be the 2014 edition,
2015 edition, or a combination of both (you might change)
• Physicians without an EHR are eligible to participate in
MIPS, but will not be able to receive any points in the ACI
category
17. Improvement Activities
There are 92 improvement activities available within the following overarching
categories:
Expanded Practice Access
Population Management
Care Coordination
Beneficiary Engagement
Patient Safety and Practice Assessment
Achieving Health Equity
Emergency Response and Preparedness
Integrated Behavioral and Mental Health
17
18. PCMH
18
• Practices recognized or certified by:
NCQA, AAAHC, TJC, URAC; and
Accrediting bodies that have
certified 500 or more practices
– 2017: One member of the TIN
could have PCMH “recognition”
for 100% IA credit
– 2018: 50% of TIN members need
PCMH “recognition” for the TIN
to receive full IA credit**
19. Annual Performance Threshold
• Established by Secretary years 1 and 2
– For transition year 2017, threshold is 3
– Proposed for 2018, threshold increases to 15
• Below = negative payment adjustments
• Above = positive payment adjustments
19
20. Adjust Payments
-4% -5% -7% -9%
4%
5%
7% 9%
2019 2020 2021 2022 onward
*Adjustment to provider’s base rate of Medicare Part B payment
*Potential for
3X
adjustment
20
21. Adjustment Summary
21
Performance Score Payment Adjustment
Exceptional Performers
(Final Score over 70)
=
Eligible for up to 10%
positive adjustment in
2019
25th Percentile or below =
Maximum negative
adjustment
At threshold = Stable Payment
22. “Pick Your Pace” Reporting
22
• Report one quality measure, one improvement activity, or all four of the
required measures within the advancing care information (ACI) category
Test
• Report a minimum of 90 days for more than one quality measure, more
than one improvement activity, or the measures within the ACI category.
Partial Participation
• Report to MIPS for a full 90-day period or full year
Full Participation
24. Definitions
Qualifying APM
• Based on existing payment models
Advanced APM
• Based on criteria of the payment model
Qualifying AAPM Participant
• Based on individual physician payment
or patient volume
24
25. Qualifying APMs
25
• MSSP (Medicare Shares Savings
Program)
• Expanded under CMS Innovation
Center Model*
• Demonstration under Medicare
Healthcare Quality Demonstrations
(MHCQ) or Acute Care Episode
Demonstration
• “Demonstration required by Federal
Law”
Qualifying
APMs
26. Advanced APM Eligibility
26
• Quality measures
comparable to MIPS
• Use of certified EHR
technology
• More than nominal risk
OR Medical Home model
expanded under CMMI
authority
Qualifying
APMs
Advanced
APMs
27. 2017 Primary Care Advanced APMs
• Shared Savings Program (Tracks 2 & 3)
• Next Generation ACO Model
• Comprehensive Primary Care Plus (CPC+)
• Vermont Medicare ACO Initiative (as part of the
Vermont All-Payer ACO Model)
27
28. Qualifying AAPM Participant
28
• Percentage of patients or
payments thru eligible APM
• In 2019, the threshold is 25%
of Medicare payments or 20%
of beneficiaries
• QP status will be determined at
the group level
Qualifying
APMs
Advanced
APMs
Qualifying
AAPM
Participant
29. Additional Rewards for
Qualifying Participants
29
• Not subject to MIPS
• 5% bonus 2019-2024
• Higher fee schedule update to 0.75% 2026
30. MACRA Timeline
2017 2018 2019 2020 2021 2022-2024 2025 2026
Medicare Part B Baseline Payment Updates
+0.5% +0.5% +0.5% 0% 0% 0%
+0.25%*
+0.75%**
*Non-qualifying APM Conversion Factor
**Qualifying APM Conversion Factor
Merit-Based Incentive Payment System (MIPS)
PQRS, Value-based
Modifier, & Meaningful Use
Quality, Cost, Advancing Care Information, & Improvement Activities
-9% -9%? 0 or +/-4%*
“Pick Your Pace”
+/-5% +/-7%
Qualifying AAPM Participant
5% Incentive payment
Excluded from MIPS
+0%
+/-9%
30
31. What Can I Do Right Now?
31
No
Participation
Test
Partial
Participation
Full
Participation
‘Pick Your Pace’
32. Employed Physicians and Residents
• MIPS scores follow
you
• MIPS scores are
publicly available
• Consider a practices’
MIPS score as you
evaluate employment
contracts
*Check out the FPM Employed Physician Supplement
33.
34. R. Shawn Martin
Senior Vice President
Advocacy, Practice Advancement, & Policy
smartin@aafp.org
@rshawnm
Editor's Notes
The Medicare Access and CHIP reauthorization Act (MACRA) is the key legislative piece that moves the healthcare system closer to meeting the goals laid out by the Secretary.
The first line in the legislation is spelled out here, and it states clearly what the law is intended to do…To repeal the Medicare Sustainable Growth Rate (the SGR) and strengthen Medicare access by improving physician payments
If only the law were this simple!
As we mentioned previously, MACRA introduces two new payment tracks:
One that consolidates quality programs –the Merit Based Incentive Payment System (MIPS)
And Alternative Payment Models (APMs) - which have the potential for bonus payments for participation
We anticipate many of our members will move through MIPS into the alternative payment model track.
Here is a graphical representation of the MACRA path you will be venturing on.
The final rule defines eligible clinicians physicians (MD/DO), Physician Assistants, Nurse Practicioners, Clinical Nurse Specialists and Certified Registered Nurse Anesthetist. Other providers will added
*You are not required, as a condition of participating in the Medicare program, to participate in either of the QPP pathways. You may elect to provide care to Medicare patients and not participate in the QPP. However, if this is your decision, you will face maximum negative payment updates as established by the law.
Lets take a look at MIPS in more detail
Highlights of MIPS include the consolidation of existing quality and value programs to reduce administrative burden; establishment of a performance score; and sliding scale payment adjustments.
In addition to the more familiar programs that will be used to calculate a MIPS composite score, a new category of clinical practice improvement activities has been introduced.
Physicians will be assessed, and receive payment adjustments, based on a composite score comprised of these four categories.
You will see that many primary care providers are already doing something (if not a lot) in each of these categories.
Physicians will be assessed, and receive payment adjustments, based on a composite score comprised of these four categories.
You will see that many primary care providers are already doing something (if not a lot) in each of these categories.
Quality – Physicians will need to report on 6 measures of their choosing- one being an outcome measure. Those that have been reporting PQRS will be familiar with this process.
Resource Use- Similar to value-based payment modifier, there will be no data submitted by physicians to CMS for this category. CMS will use claims data to calculate the score.
Advancing Care Information- which is the old Meaningful Use, is reported very much the same as the previous program.
Then, there is the new category of Clinical Practice Improvement Activities
This is a breakdown of year 1 scoring. The four categories above contribute points, in a weighted fashion, to make up the performance score. The total number of points scored will range from 0-100, with each category weighted as established in statue.
Quality 60%
Cost 0%
IA 15
ACI 25
You will notice there is a footnote for Improvement Activites. Specifically, a “Certified” patient centered medical home will receive the full 15 points for this category. Those in alternative payment models who do not qualify for the alternative payment model bonus, will get half the credit for the IA category. We will discuss this more in the alternative payment model section.
“Certified” patient centered medical home is defined in the proposed rule as those recognized by NCQA, the Joint Commission, URAC, and AAAHC. The AAFP is advocating for state-based and payer programs to be included in this definition as well.
If choosing to report as a group, then all performance categories must be reported and will be scored as a group.
If reporting as a group, all clinicians within the group must report on the same measures
There are 9 outcomes measures in the Family Medicine set
The exception to the 20 patient case minimum is the all cause hospital readmission measure which is a 200 case minimum
The ACI performance category replaces meaningful use. Similar to meaningful use, eligible clinicians (ECs) must use certified EHR technology (CEHRT) to report for the ACI performance category. The CEHRT may be the 2014 edition, 2015 edition, or a combination of both. Physicians without an EHR are eligible to participate in MIPS, but will not be able to receive any points in the ACI category.
When MIPS begins in 2019, there is no historical “look back” period of previous MIPS scores to use to set a performance threshold. The law gives authority to the Secretary of Health & Human Services to establish the performance threshold in years one and two.
After that, the performance threshold will be based on the mean or median of the previous year’s MIPS scores.
MIPS scores will then be compared to the threshold. Scores above the threshold will yield positive payment adjustments and scores below the threshold negative adjustments.
Beyond the baseline adjustments, written into the law are higher adjustments for the highest performers. These can be up to 3 times the maximum adjustment for that year.
But the positive and negative adjustments must still be budget neutral.
Also, positive and negative adjustments will be made on a sliding scale, which is important. People will likely get a wide range of adjustments between 0 and the maximum for the year, not necessarily in whole numbers. We may be seeing adjustments carried out several decimal points. At this time, we don’t know.
It is important to note, the adjustments are not cumulative, whether positive or negative. Every year, your baseline resets to zero.
Outside the budget neutral adjustments, for years 2019-2024, there is $500M set aside for additional positive payment adjustments of up to 10% for “exceptional performers”. As the proposed rule is written, exceptional performers will be those that score in the top 25% of MIPS scores.
Before leaving this slide, an important note for lower performers who score in the lowest quartile of MIPS scores: These providers will automatically be adjusted down to the maximum penalty for that year
Here are some key points to remember: If you score in the lowest quartile of MIPS scores, you will automatically be adjusted down to the maximum payment adjustment for the performance year.
If you score at threshold, you receive no adjustment
Exceptional performers are eligible for a potential positive payment adjustment up to 10%. This incentive will be paid based on a sliding scale and is outside the budget neutrality. $500M has been set aside to cover this incentive payment. Exceptional has been proposed to be the top 25% of MIPS scores.
And it is important to remember, this program is budget neutral, so the total negative adjustments must equal the total positive adjustments.
Let’s move on to APMs
As we’ve mentioned, most providers will move through MIPS as they prepare to enter the Alternative Payment Model track.
At the highest level, MIPS is based on existing activities with few entry requirements or exceptions making it easy to become a participant.
Conversely, in the APM track, you must meet specific qualification and eligibility criteria. Let’s talk about what each of these mean.
The goal is for you to be a Qualifying APM Participant.
The first step to get there is to be practicing in a “qualifying” payment model defined in the law. MACRA is very specific about which models qualify, and they are listed here.
Although this is a wide net cast for qualification it does get smaller as we move through the next steps of eligibility and further qualification.
Step two in the process is for qualified APMs to meet eligibility criteria, listed here. Let’s take a closer look.
First, Advanced APMs must report measures comparable to those in MIPS.
Second, they must use certified EHR technology
And, this last bullet is interesting. The APM needs to either 1) bear more than nominal financial risk for monetary losses, OR 2) be a medical home model expanded under CMMI authority.
Nominal financial risk has been defined in the proposed rule and it is very complicated. The AAFP is advocating the definition be simplified.
In the proposed rule, CMS defined those programs that met the criteria necessary to be considered an Advanced APM. They have said they will release an updated list of Advanced APMs annually.
The last step after the payment model has been identified as an Advanced APM, is for the participants within the model to be qualified.
Qualifying Participants (QPs) are physicians and practitioners who have a certain percentage of their patients or payments coming through an Advanced APM.
In 2019 and 2020, the threshold for claims is 25% of payments made by CMS for part B services to Medicare attributed beneficiaries paid through the Advanced APM.
The patient threshold is 20% of Medicare unique attributed beneficiaries. This is not a total percentage of your patient panel, this is just a percentage of your Medicare attributed patients.
Beginning in 2021, the threshold percentage may be reached through a combination of Medicare and other non-Medicare payer arrangements, such as private payers and Medicaid
Qualifying APM participants are excluded from MIPS, and will receive an annual 5% bonus payment from 2019-2024. They will also receive a higher Medicare physician fee schedule update (of 0.75%) starting in 2026.
Physicians and practitioners who participate in qualifying APMs that are not an Advanced APM are not a “qualifying participant” and will be subject to MIPS.
However, APM participation is a clinical practice improvement activity, as defined under MIPS. As a result, these APM participants will receive favorable scoring for this performance category.
And finally, the full timeline.
The timeline illustrates the payment updates, and the penalties and/or benefits by year for both MIPS and Qualifying APM Participants.
This timeline is available on the AAFP website
So, What Can You Do Right Now to take advantage of the payment opportunities?