CMS Innovation and Health Care Delivery System Reform

Maine Chapter of the American Health Information Management Association March 17, 2 016 Andy Finnegan CMS RO1

Better. Smarter. Healthier. So we will continue to work across sectors and across the aisle for the goals we share: better care, smarter spending, and healthier people.

CMS support of health care Delivery System Reform will result in better care, smarter spending, and healthier people

Key characteristics

3

Producer-centered Incentives for volume Unsustainable Fragmented Care

Systems and Policies Fee-For-Service Payment

Systems

Key characteristics Patient-centered Incentives for outcomes Sustainable Coordinated care

Systems and Policies Value-based purchasing Accountable Care Organizations Episode-based payments Medical Homes Quality/cost transparency

Public and Private sectors

Evolving future state Historical state

Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system.

Delivery System Reform requires focusing on the way we pay providers, deliver care, and distribute information

{ } “

Pay Providers

4 Source: Burwell SM. Setting Value-Based Payment Goals ─ HHS Efforts to Improve U.S. Health Care. NEJM 2015 Jan 26; published online first.

Deliver Care

Distribute Information

FOCUS AREAS

5

What is “MACRA”?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 1 6, 2015.

What does Title I of MACRA do?

• Repeals the Sustainable Growth Rate (SGR) Formula • Changes the way that Medicare rewards clinicians for value

over volume • Streamlines multiple quality programs under the new Merit-

Based Incentive Payments System (MIPS) • Provides bonus payments for participation in eligible

alternative payment models (APMs)

CMS has adopted a framework that categorizes payments to providers

Description

Medicare Fee-for- Service examples

Payments are based on volume of services and not linked to quality or efficiency

Category 1: Fee for Service – No Link to Value

Category 2: Fee for Service – Link to Quality

Category 3: Alternative Payment Models Built on Fee-for-Service Architecture

Category 4: Population-Based Payment

At least a portion of payments vary based on the quality or efficiency of health care delivery

6 Source: Rajkumar R, Conway PH, Tavenner M. CMS ─ engaging multiple payers in payment reform. JAMA 2014; 311: 1967-8.

Some payment is linked to the effective management of a population or an episode of care Payments still triggered by

delivery of services, but opportunities for shared savings or 2-sided risk

Payment is not directly triggered by service delivery so volume is not linked to payment Clinicians and

organizations are paid and responsible for the care of a beneficiary for a long period (e.g., ≥1 year)

Limited in Medicare fee- for-service Majority of

Medicare payments now are linked to quality

Hospital value- based purchasing Physician Value

Modifier Readmissions /

Hospital Acquired Condition Reduction Program

Accountable Care Organizations Medical homes Bundled payments Comprehensive Primary Care

initiative Comprehensive ESRD Medicare-Medicaid Financial

Alignment Initiative Fee-For- Service Model

Eligible Pioneer Accountable Care Organizations in years 3-5 Maryland hospitals

During January 2015, HHS announced goals for value-based payments within the Medicare FFS system

7

2016

30%

85%

2018

50%

90%

Target percentage of payments in ‘FFS linked to quality’ and ‘alternative payment models’ by 2016 and 2018

2014

~20%

>80%

2011

0%

~70%

Goals Historical Performance

Alternative payment models (Categories 3-4) FFS linked to quality (Categories 2-4) All Medicare FFS (Categories 1-4)

8

9

CMS will achieve Goal 1 through alternative payment models where providers are accountable for both cost and quality

Major APM Categories 2014 2015 2016 2017 2018

ESRD Prospective Payment System*

Other Models Maryland All-Payer Hospital Payments*

Comprehensive ESRD Care Model

Accountable Care Organizations

Medicare Shared Savings Program ACO*

Pioneer ACO*

CMS will continue to test new models and will identify opportunities to expand existing models

* MSSP started in 2012, Pioneer started in 2012, BPCI started in 2013, CPC started in 2012, MAPCP started in 2011, Maryland All Payer started in 2014 ESRD PPS started in 2011

Bundled Payments

Bundled Payment for Care Improvement*

Specialty Care Models

Advanced Primary Care

Comprehensive Primary Care*

Multi-payer Advanced Primary Care Practice*

Model completion or expansion

Next Generation ACO

CMS is aligning with private sector and states to drive delivery system reform

CMS Strategies for Aligning with Private Sector and states

Convening Stakeholders Incentivizing Providers

Partnering with States

10

The Health Care Payment Learning and Action Network will accelerate the transition to alternative payment models

Medicare alone cannot drive sustained progress towards alternative payment models (APM)

Success depends upon a critical mass of partners adopting new models

The network will Convene payers, purchasers, consumers, states and

federal partners to establish a common pathway for success

Identify areas of agreement around movement to APMs Collaborate to generate evidence, shared approaches,

and remove barriers Develop common approaches to core issues such as

beneficiary attribution Create implementation guides for payers and purchasers

Network Objectives • Match or exceed Medicare

alternative payment model goals across the US health system

-30% in APM by 2016 -50% in APM by 2018

• Shift momentum from CMS

to private payer/purchaser and state communities

• Align on core aspects of

alternative payment design

11

Accountable Care Organizations: Participation in Medicare ACOs growing rapidly

* April 2015 12

423 ACOs have been established in the MSSP and Pioneer ACO programs* 7.9 million assigned beneficiaries This includes 89 new ACOS covering 1.6 million beneficiaries assigned to the shared

saving program in 2015 ACO-Assigned Beneficiaries by County

Medicare Shared Savings Program: Results to date

1 2013 figures include both 2012 and 2013 savings / loss generated for some ACOs that started mid-year in 2012 (these were the first ACOs in the program) 13

Financial Results In 2014: 92 ACOs (28%) held spending $806 million below their targets and

earned performance payments of more than $341 million

In 20131: 58 ACOs (26%) held spending $705 million below their targets and

earned performance payments of more than $315 million

Quality Results ACOs that reported in both 2013 and 2014 improved average performance

on 27 of 33 quality measures

Quality improvement was shown in such measures as patients’ ratings of

clinicians’ communication, beneficiaries’ rating of their doctor, screening for tobacco use and cessation, and screening for high blood pressure

Pioneer ACOS were designed for organizations with experience in coordinated care and ACO-like contracts

Pioneer ACOs generated savings for three years in a row Total savings of $92 million in PY1, $96 million in PY2, and $120 million in PY3‡

Average savings per ACO increased from $2.7 million in PY1 to $4.2 million in PY2 to $6.0 million in PY3‡

Pioneer ACOs showed improved quality outcomes Mean quality score increased from 72% to 85% to 87% from 2012–2014 Average performance score improved in 28 of 33 (85%) quality measures in PY3

Elements of the Pioneer ACO have been incorporated into track 3 of MSSP

Pioneer ACOs meet requirement for expansion after two years and continued to generate savings in performance year 3

19 ACOs operating in 12 states (AZ, CA, IA, IL, MA, ME, MI, MN, NH, NY, VT, WI) reaching over 600,000 Medicare fee-for-service beneficiaries

Duration of model test: January 2012 – December 2014; 19 ACOs extended for 2 additional years

‡ Results from actuarial analysis 14

Independence at Home (IAH) Demonstration saves more than $3,000 per beneficiary

There are 17 total practices, including 1 consortium, participating in the model

Approximately 8,400 patients enrolled in the first year

Duration of initial model test: 2012 - 2015

15

IAH tests a service delivery and shared savings model using home-based primary care to improve health outcomes and reduce expenditures for high- risk Medicare beneficiaries

In year 1, demo produced more than $25 million in savings, an average of $3,070 per participating beneficiary per year

CMS will award incentive payments of $11.7 million to nine practices that produced savings and met the designated quality measures for the first year

All 17 participating practices improved quality in at least three of the six quality measures

Multi-payer Advanced Primary Care Practice (MAPCP) Demonstration has generated net savings

Medicare participated in 8 state-led multi-payer patient centered medical home (PCMH) initiatives in partnership with Medicaid and commercial payers

CMS supports these multi-payer PCMH initiatives through: Enhanced, non-visit-based payments to practices, community-based support

teams, and states Quarterly data feedback

Gross savings of $40.3 million and net savings of $4.2 million were observed

Initially 8 states (ME, MI, MN, NC, NY, PA, RI, VT) encompassing more than 4,000 providers, 700 practices, and 350,000 Medicare fee-for-service beneficiaries participating in the first year

Duration of initial model test: July 2011 – December 2014

ME, MI, NY, RI, VT were extended through Dec 2016

16

Comprehensive Primary Care (CPC) is showing early positive results

7 regions (AR, OR, NJ, CO, OK, OH/KY, NY) encompassing 31 payers, nearly 500 practices, and approximately 2.5 million multi-payer patients

Duration of model test: Oct 2012 – Dec 2016

CMS convenes Medicaid and commercial payers to support primary care practice transformation through enhanced, non-visit-based payments, data feedback, and learning systems

In program year 1 across all 7 regions, CPC reduced Medicare Part A and B

expenditures per beneficiary by $14 or 2%*

Reductions appear to be driven by initiative-wide impacts on hospitalizations, ED visits, and unplanned 30-day readmissions

18 * Reductions relative to a matched comparison group and do not include the care management fees (~$20 pbpm)

Partnership for Patients contributes to quality improvements

18

Leading Indicators, change from 2010 to 2013

Data shows…

Ventilator- Associated Pneumonia

Early Elective Delivery

Central Line- Associated

Blood Stream Infections

Venous thromboembolic complications

Re- admissions

62.4% ↓ 70.4% ↓ 12.3% ↓ 14.2% ↓ 7.3% ↓

The CMS Innovation Center was created by the Affordable Care Act to develop, test, and implement new payment and delivery models

“The purpose of the [Center] is to test innovative payment and service delivery models to reduce program expenditures…while preserving or enhancing the quality of care furnished to individuals under such titles”

Section 3021 of Affordable Care Act

Three scenarios for success 1. Quality improves; cost neutral 2. Quality neutral; cost reduced 3. Quality improves; cost reduced (best case) If a model meets one of these three criteria and other statutory prerequisites, the statute allows the Secretary to expand the duration and scope of a model through rulemaking

19

The Innovation Center portfolio aligns with delivery system reform focus areas

Pay Providers

− Pioneer ACO Model − Medicare Shared Savings Program (housed in Center for

Medicare) − Advance Payment ACO Model − Comprehensive ERSD Care Initiative − Next Generation ACO

Primary Care Transformation − Comprehensive Primary Care Initiative (CPC) − Multi-Payer Advanced Primary Care Practice (MAPCP)

Demonstration − Independence at Home Demonstration − Graduate Nurse Education Demonstration − Home Health Value Based Purchasing − Medicare Care Choices

Focus Areas CMS Innovation Center Portfolio* Test and expand alternative payment models

Accountable Care

23 * Many CMMI programs test innovations across multiple focus areas

Bundled payment models − Bundled Payment for Care Improvement Models 1-4 − Oncology Care Model − Comprehensive Care for Joint Replacement (proposed)

Initiatives Focused on the Medicaid − Medicaid Incentives for Prevention of Chronic Diseases − Strong Start Initiative − Medicaid Innovation Accelerator Program

Dual Eligible (Medicare-Medicaid Enrollees) − Financial Alignment Initiative − Initiative to Reduce Avoidable Hospitalizations among

Nursing Facility Residents

Medicare Advantage (Part C) and Part D − Medicare Advantage Value-Based Insurance Design model − Part D Enhanced Medication Therapy Management

Deliver Care Support providers and states to improve the delivery of care

Learning and Diffusion State Innovation Models Initiative − Partnership for Patients ‒ SIM Round 1 − Transforming Clinical Practice ‒ SIM Round 2 − Community-Based Care Transitions ‒ Maryland All-Payer Model

Health Care Innovation Awards Million Hearts Cardiovascular Risk Reduction Model

Distribute Information

Increase information available for effective informed decision-making by consumers and providers

Health Care Payment Learning and Action Network Information to providers in CMMI models Shared decision-making required by many models

Next Generation ACO Model builds upon successes from Pioneer and MSSP ACOs

Designed for ACOs that are experienced in coordinating care for populations of patients

These ACOs will assume higher levels of financial risk and reward than the Pioneer or MSSP ACOS

The model will test how strong financial incentives for ACOs can improve health outcomes and reduce expenditures

Greater opportunities to coordinate care (e.g., telehealth and skilled nursing facilities)

More predictable financial targets

Model Principles • Prospective attribution • Financial model for long-

term stability • Reward quality • Benefit enhancements that

improve patient experience • Protect freedom of choice • Allow beneficiaries to

choose alignment with ACO • Smooth ACO cash flow and

improved investment capabilities

25

26

The bundled payment model targets 48 conditions with a single payment for an episode of care Incentivizes providers to take accountability for both cost and quality of

care Four Models

- Model 1: Retrospective acute care hospital stay only - Model 2: Retrospective acute care hospital stay plus post-acute care - Model 3: Retrospective post-acute care only - Model 4: Acute care hospital stay only

360 Awardees and 1755 Episode Initiators in Phase 2 as of July 2015

Bundled Payments for Care Improvement is also growing rapidly

Duration of model is scheduled for 3 years: Model 1: April 2013 to present Models 2, 3, 4: October 2013 to present

* Current until July 2015

27

Oncology Care Model: new emphasis on specialty care

1.6 million people annually diagnosed with cancer; majority are over 65 years

Major opportunity to improve care and reduce cost

Model Objective: Provide beneficiaries with higher intensity coordination to improve quality and decrease cost

Key features Implement 6 part practice transformation Create two part financial incentive with $160 pbpm,

payment and performance based payment Institute robust quality measurement Engage multiple payers

Practice Transformation

1.Patient navigation

2.Care plan with 13 components based on IOM Care Management Plan

3.24/7 access to clinician and

real time access to medical records

4.Use of therapies consistent

with national guidelines

5.Data driven continuous quality improvement

6.ONC certified electronic

health record and stage 2 meaningful use by year 3

28

The proposed model tests bundled payment of lower extremity joint replacement

Payment model would apply to most Medicare LEJR procedures within

select geographic areas with few exceptions Payment model would be implemented through rulemaking

Participants would include Inpatient Prospective Payment System Hospitals

in selected Metropolitan Statistical Areas (MSA) not participating in phase II of the Bundled Payment for Care Improvement model

Participating areas were selected in a two-step randomization process

MSAs were placed into five groups based on their historic LEJR episode payment and population size

MSAs were then randomly selected within each group

Proposed Comprehensive Care for Joint Replacement would test a bundled payment model across a broad cross section of hospitals

* Current until October 2015

Comprehensive ESRD Care will improve patient centered coordination of care

ESRD patients represent 1% of Medicare beneficiaries but account for 8% of payments

ESRD PPS accounts for approximately 33% of total cost of care for ESRD patient Opportunity exist to improve patient centered care that

coordinates dialysis care with care outside of dialysis

CEC model will improve care coordination through the creation of ESRD Seamless Care Organizations (ESCO) that will include dialysis providers, nephrologist, and other medical providers

ESCOs can be formed by Medicare certified dialysis facilities, nephrologist, certain other Medicare enrolled providers and suppliers

Care Model

• Improve care coordination • Clinical and support

services • Data driven, population

care management

• Enhance communication between providers • Whole-patient care

management • EHR information

exchange among providers

• Increase access to care • After hours call-in line;

extended business hours • Enhanced convenience

through on-site ‘rounding’

25

Medicare Advantage Value Based Insurance Design Model offers more flexibility to Medicare Advantage Plans

Allows MA plans to structure enrollee cost-sharing and other health plan design elements to encourage enrollees to use clinical services that have the greatest potential to positively impact on enrollee health

Will begin on January 1, 2017 and run for 5 years

Plans in 7 states will be eligible to participate

Arizona, Indiana, Iowa, Massachusetts, Oregon, Pennsylvania, and Tennessee

Eligible Medicare Advantage plans in these states, upon approval from CMS,

can offer varied plan benefit design for enrollees who fall into certain clinical categories identified and defined by CMS

Changes to benefit design made through this model may reduce cost-sharing

and/or offer additional services to targeted enrollees 26

Part D Enhanced Medication Therapy Management (MTM) Model

27

Enhanced MTM, when implemented correctly, can improve health care and outcomes for patients and has the potential to lower overall health costs

The model will assess whether additional incentives and flexibilities to

design and implement programs will achieve improving compliance with medication protocols reducing medication-related problems increasing patients’ knowledge of their medications improving communication among prescribers, pharmacists, caregivers and patients

Will begin January 1, 2017 with a 5 year performance period CMS will test the model in 5 part D regions

Region 7 (Virginia) Region 11 (Florida), Region 21 (Louisiana), Region 25 (Iowa, Minnesota, Montana, Nebraska, North Dakota, South Dakota, Wyoming) Region 28 (Arizona).

32

Million Hearts Cardiovascular Disease Risk Reduction Model will reward population-level risk management

Heart attacks and strokes are a leading cause of death and disability in the United States Prevention of cardiovascular disease can significantly reduce

both CVD-related and all-cause mortality

Participant responsibilities Systematic beneficiary risk calculation* and stratification Shared decision making and evidence-based risk modification Population health management strategies Reporting of risk score through certified data registry

Eligible applicants General/family practice, internal medicine, geriatric medicine,

multi-specialty care, nephrology, cardiology Private practices, community health centers, hospital-owned

practices, hospital/physician organizations

Payment Model • Pay-for-outcomes

approach • Disease risk assessment

payment - One time payment to

risk stratify eligible beneficiary

- $10 per beneficiary

• Care management payment - Monthly payment to

support management, monitoring, and care of beneficiaries identified as high-risk

- Amount varies based upon population-level risk reduction

*Uses American College of Cardiology/American Heart Association (ACA/AUA) Atherosclerotic Cardiovascular Disease (ASCVD) 10-year pooled cohort risk calculator

Medicare Care Choices Model (MCCM) provides new options for hospice patients

MCCM allows Medicare beneficiaries who qualify for hospice to receive palliative care services and curative care at the same time. Evidence from private market that can concurrent care can improve outcomes, patient and family experience, and lower costs.

MCCM is designed to Increase access to supportive care services provided by hospice; Improve quality of life and patient/family satisfaction; Inform new payment systems for the Medicare and Medicaid

programs.

Model characteristics Hospices receive $400 PBPM for providing services for 15 days

or more per month 5 year model Model will be phased in over 2 years with participants randomly

assigned to phase 1 or 2

Services The following services are available 24 hours a day, 7 days a week

• Nursing

• Social work

• Hospice aide

• Hospice homemaker

• Volunteer services

• Chaplain services

• Bereavement services

• Nutritional support

• Respite care

29

CMS is testing the ability of state governments to utilize policy and regulatory levers to accelerate health care transformation

Primary objectives include

Improving the quality of care delivered Improving population health Increasing cost efficiency and expand value-based payment

State Innovation Model grants have been awarded in two rounds

Six round 1 model test states

Eleven round 2 model test states

Twenty one round 2 model design states

30

Round 1 states are testing and Round 2 states are designing and implementing comprehensive reform plans Round 1 States testing APMs

Patient centered medical Health Accountable homes homes care Episodes

Arkansas

Maine

Massachusetts

Minnesota

Oregon

Vermont

Round 2 States designing interventions Near term CMMI objectives Establish project milestones and

success metrics

Support development of states’

stakeholder engagement plans

Support development and

refinement of operational plans

31

Awards tested service delivery and payment models that improved quality and decreased cost in communities across the U.S.

107 projects awarded

Ideas tested include - Enhancing primary care - Coordinating care across multiple settings - New types of health care workers - Improving decision making - Testing new service delivery technologies

Round 1 of the Health Care Innovation Awards tested a broad range of delivery system innovations

Approximately 575,000 Medicare, Medicaid, and CHIP beneficiaries served

Projects were funded in all 50 states*

Awards ranged from ~$1 M to $30 M

32 * Darker colors on map represent more HCIA projects in that state

39 projects awarded

Increase focus on four areas that have high likelihood of driving health care system transformation and delivering better outcomes 1. Reduce Medicare, Medicaid, and CHIP expenditure in outpatient and/or post-acute

settings 2. Improve care for populations with specialized needs 3. Transform the financial and clinical models for specific types of providers and suppliers 4. Improve the health of populations

Round 2 of the Health Care Innovation Awards shared goals with Round 1 but focused on four themes

27 states and the District of Columbia*

Awards ranged from ~$2 M to $24 M

33 * Darker colors on map represent more HCIA projects in that state

Transforming Clinical Practice Initiative is designed to help clinicians achieve large-scale health transformation

• The model will support over 150,000 clinician practices over the next four years to improve on quality and enter alternative payment models

Phases of Transformation

34

• Two network systems will be created

1) Practice Transformation Networks: peer-based learning networks designed to coach, mentor, and assist

2) Support and Alignment

Networks: provides a system for workforce development utilizing professional associations and public- private partnerships

Alternative Payment Models (APMs)

CMS Innovation Center model (under section 1 1 1 5A, other than a Health Care Innovation Award)

MSSP (Medicare Shared Savings Program)

Demonstration under the Health Care Quality Demonstration Program

Demonstration required by Federal Law

According to MACRA law, APMs include:

APMs are new approaches to paying for medical care through Medicare that incentivize quality and value.

35

• MACRA does not change how any particular APM rewards value. • APM participants who are not “QPs” will receive favorable scoring under

MIPS. • Only some of these APMs will be eligible APMs.

How does MACRA provide additional rewards for participation in APMs?

APM participants

QPs

Those who participate in the most advanced APMs may be determined to be qualifying APM participants (“QPs”). As a result, QPs: 1. Are not subject to MIPS 2. Receive 5% lump sum bonus payments for years

2019-2024 3. Receive a higher fee schedule update for 2026 and

onward

36

Most physicians and practitioners who participate in APMs will be subject to MIPS and will receive favorable scoring under the MIPS clinical practice improvement activities performance category.

What is an eligible APM?

Eligible APMs are the most advanced APMs that meet the following criteria according to

the MACRA law:

Base payment on quality measures comparable to those in MIPS

Require use of certified EHR technology

Either (1) bear more than nominal financial risk for monetary losses OR (2) be a medical home model expanded under CMMI authority

37

How do I become a qualifying APM participant (QP)?

QPs are physicians and practitioners who have a certain % of their patients or

payments through an eligible APM.

Beginning in 2021 , this threshold % may be reached through a combination of

Medicare and other non-Medicare payer arrangements, such as private payers

and Medicaid.

QPs: 1. Are not subject to MIPS 2. Receive 5% lump sum bonus payments for years

2019-2024 3. Receive a higher fee schedule update for 2026 and

onward

eligible APM QP

38

Potential value-based financial rewards

MIPS adjustments

MIPS only eligible APMs

39

APM-specific rewards

+ MIPS adjustments

APMs

eligible APM-

specific rewards

+ 5% lump sum

bonus

• APMs—and eligible APMs in particular—offer greater potential risks and rewards than MIPS. • In addition to those potential rewards, MACRA provides a bonus payment to providers committed

to operating under the most advanced APMs.

Recall: How MACRA get us closer to meeting HHS payment reform goals

2016 2018

New HHS Goals:

30%

85%

50%

90%

The Merit-based Incentive Payment System helps to link fee-for-service payments to

quality and value.

The law also provides incentives for participation in Alternative Payment Models via the bonus

payment for Qualifying APM Participants (QPs) and favorable

scoring in MIPS for APM participants who are not QPs.

All Medicare fee-for-service (FFS) payments (Categories 1-4)

Medicare FFS payments linked to quality and value (Categories 2-4)

Medicare payments linked to quality and value via APMs (Categories 3-4)

Medicare payments to QPs in eligible APMs under MACRA 40

How will MACRA affect me?

Qualifying APM Participant • 5% lump sum bonus payment 2019-2024 • Higher fee schedule updates 2026+ • APM-specific rewards • Excluded from MIPS

Subject to MIPS

Bottom line: There are opportunities for financial incentives for participating in an APM, even if you don’t become a QP.

Am I in an APM?

Yes No

• Subject to MIPS • Favorable MIPS scoring • APM-specific rewards

Am I in an eligible APM?

Yes No

Do I have enough payments or patients through my eligible

APM? Yes No

Is this my first year in Medicare OR am I below the low-volume

threshold?

Yes No

Not subject to MIPS

A single MIPS composite performance score will factor in performance in 4 weighted performance categories:

MIPS Composite

Performance Score

Quality Resource use

Meaningful

use of certified EHR technology

Clinical practice

improvement activities

How will physicians and practitioners be scored under MIPS?

42

How much can MIPS adjust payments?

• Based on the MIPS composite performance score, physicians and practitioners will receive positive, negative, or neutral adjustments up to the percentages below.

• MIPS adjustments are budget neutral. A scaling factor may be applied to upward adjustments to make total upward and downward adjustments equal.

MAXIMUM Adjustments

Adjustment to provider ’s base rate of

Medicare Part B

payment

2019 2020 2021 2022 onward

Merit-Based Incentive Payment System

(MIPS)

4% 5% 7% 9%

-4%-5% -7%

43

-9%

18

Through MACRA, HHS aims to:

45

• Offer multiple pathways with varying levels of risk and reward for providers to tie more of their payments to value.

• Over time, expand the opportunities for a broad range of providers to participate in APMs.

• Minimize additional reporting burdens for APM participants. • Promote understanding of each physician’s or practitioner ’s

status with respect to MIPS and/or APMs. • Support multi-payer initiatives and the development of APMs

in Medicaid, Medicare Advantage, and other payer arrangements.

MACRA Goals

Disclaimers

46

This presentation was prepared as a tool to assist providers and is not intended to grant rights or impose obligations. Although every reasonable effort has been made to assure the accuracy of the information within these pages, the ultimate responsibility for the correct submission of claims and response to any remittance advice lies with the provider of services. This presentation is a general summary that explains certain aspects of the Medicare Program, but is not a legal document. The official Medicare Program provisions are contained in the relevant laws, regulations, and rulings. Medicare policy changes frequently, and links to the source documents have been provided within the document for your reference The Centers for Medicare & Medicaid Services (CMS) employees, agents, and staff make no representation, warranty, or guarantee that this compilation of Medicare information is error-free and will bear no responsibility or liability for the results or consequences of the use of this guide. .