Macra review

Macra review

• 1.
  MACRA Review Making senseof it all
• 2.
  MACRA = MedicareAccess 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-basedIncentive 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 CareInformation (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 • Medicareallowable 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