MACRA combines several existing quality programs into the new MIPS program or allows participation in Advanced APMs. MIPS has four performance categories (quality, advancing care information, improvement activities, and cost). In 2017, physicians will submit baseline data for these categories to determine 2019 payment adjustments. Physicians have options to fully participate, partially participate, or test MIPS requirements. Those in Advanced APMs may receive a 5% incentive payment. Over 50% of physicians are estimated to be exempt from MIPS requirements.

1. MACRA Review
Making sense of it all

2. MACRA = Medicare Access and CHIP
Reauthorization Act of 2015
• Physicians participating in Medicare, or provide Part B services, have
two choices:
• MIPS: Merit-based Incentive Payment System
• APM: Advanced Payment Model

3. MIPS = Merit-based Incentive Payment
System
• Combines: PQRS, Value-based Modifier, and Meaningful Use
• Includes 4 performance categories
• Quality
• Advancing care information
• Improvement activities
• Cost
• 2017 will be used as the baseline year for 2019 MIPS payment year
• Performance in the 4 categories will determine performance score
and payment rate

4. MIPS Performance Scoring
• 2017 performance threshold is to get 3/100 possible points
• 90% of physicians will achieve this goal and not get a negative
payment adjustment in 2019
• 70/100 score or better will be eligible for payment from a $500M pool
(“exceptional performance adjustment”)
• 2017 performance score comprised of:
• Quality = 60%
• Advancing Care Information = 25%
• Improvement Activities = 15%
• Cost = 0%

5. MIPS Quality Scoring (60%)
• Reporting requires on 6 quality measures, one of which must be an
outcome measure
• Quality measures selected annually and published by November 1

6. MIPS Advancing Care Information (25%)
• Reporting required on 4 measures
• Reporting required for at least 90 days

7. MIPS Improvement Activities (15%)
• PCMH practices will automatically receive highest potential score
• PCMH definition expanded
• Small and rural practices required to report 1 high-weighted or 2
medium-weighted activities for full points

8. MIPS Cost (0%)
• Calculated from adjudicated claims: no data submission required
• Will increase to 10% for 2018

9. “Pick Your Pace”
• Practices can choose 4 options:
• Test: submit minimal data and avoid downward payment. Minimum can be 1
quality measure, 1 improvement activity, or only 4 advancing care information
measures
• Partial Participation: >1 quality measure, >1 improvement activity, or ># of
required advancing care information for at least 90 days…may earn neutral or
small positive payment adjustment in 2019
• Full Participation: submission of full data for 90 days or a full year of 2017
data may earn moderate positive payment adjustment in 2019
• Advanced APM: if physician receives >25% of part B or 20% of Medicare
patient population in an APM, they’ll receive a 5% incentive boost in 2019
• Failure to report will result in a 4% penalty in 2019

10. MIPS Exemptions
• Medicare allowable charges <$30k/year OR
• Patient panel for Medicare <100 patients
• Participation in an APM
• CMS estimates that >50% of docs will be excluded:
• Not MIPS-eligible (14%)
• Too low volume
• APM Participant (5-8%)

11. Advanced APM = Advanced Payment Models
• Eligible for 5% bonus payment
• Up to 25% of docs may be eligible in 2018 year
• Requirements for APM
• Use certified EMR
• Report on MIPS quality measures
• And either:
• Be a Medical Home Model under CMS Innovation Center authority or
• Be at risk for more than a nominal amount of monetary losses