MACRA Ready - Martin
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Transcript of MACRA Ready - Martin
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MACRA: Medicare’s Shift to
Value-based Delivery &
Payment Models
Shawn Martin
AAFP Senior Vice President
Advocacy, Practice Advancement, & Policy
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What Does MACRA Do?
• Consolidates quality programs
Merit-Based Incentive Payment System (MIPS)
• Potential for bonus payment for participation
Advanced Alternative Payment Models (AAPM)
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2017/2018 QPP Participants
Physicians
(MD/DO)Physician
Assistant
Nurse
Practitioner
Clinical
Nurse
Specialist
Certified
Registered
Nurse
Anesthetist
MACRA defines eligible clinicians as:
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MIPS Exemptions
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• 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
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Merit-Based Incentive Payment System
(MIPS)
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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
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MIPS Performance Categories
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Quality Cost Improvement
Activities
Advancing
Care
Information
(ACI)
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Weighting by Category - 2017
Quality, 60%
Cost, 0%
Improvement Activities1, 15%
Advancing Care Information,
25%
1 - “Certified” PCMH receives
the full credit for IA; APM
Participants receive half credit
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Weighting Progression
**Proposed for 2018
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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
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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
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Cost Category Weight- 2017
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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
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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
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PCMH
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• 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**
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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
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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
3Xadjustment
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Adjustment Summary
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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
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“Pick Your Pace” Reporting
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• 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
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Advanced Alternative Payment Models
(AAPMs)
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DefinitionsQualifying 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
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Qualifying APMs
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• 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
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Advanced APM Eligibility
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• 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
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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)
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Qualifying AAPM Participant
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• 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
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Additional Rewards for
Qualifying Participants
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• Not subject to MIPS
• 5% bonus 2019-2024
• Higher fee schedule update to 0.75% 2026
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MACRA Timeline2017 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 UseQuality, 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%
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What Can I Do Right Now?
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No Participation
TestPartial
ParticipationFull
Participation
‘Pick Your Pace’
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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
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R. Shawn MartinSenior Vice President
Advocacy, Practice Advancement, & Policy
@rshawnm
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