Medicare Access & CHIP Reauthorization Act of 2015 (MACRA ... · What is MACRA? •Proposed rule...
Transcript of Medicare Access & CHIP Reauthorization Act of 2015 (MACRA ... · What is MACRA? •Proposed rule...
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Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Part II
Alex Goulding
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Agenda
• Overview
• Path 1: MIPS
• Path 2: Eligible APMs
• Additional resources
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OVERVIEW
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What is MACRA?
• Proposed rule targeted for spring 2016
• Final rule targeted for fall 2016
• Permanently repeals SGR
• Changes the way Medicare rewards clinicians for value over volume
• Two paths– #1: Streamlines existing quality reporting
programs into one system under MIPS
– #2: Provides bonus payments for participation in eligible APMs
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MACRA goals
Offer multiple pathways with varying levels of risk and rewards to tie more payments to value
Expand opportunities for a broad range of providers to participate in APMs
Minimize reporting burdens for APMs
Promote understanding of each clinician’s status with respect to MIPS/APMs
Support multi-payer initiatives and the development of APMs in Medicaid, Medicare Advantage and other payer arrangements
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Medicare fee-for-service
30%Medicare payments are tied to quality or value through APMs by the end of 2016, and 50% by the end of 2018
Goal 1:85%
Medicare fee-for-service payments are tied to quality or value by the end of 2016, and 90% by the end of 2018
Goal 2:
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Timeline
Source: CMS.gov (https://goo.gl/54ON3Y)
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PATH 1: MIPS
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Path 1: Merit-based Incentive Payment System (MIPS)
MIPS
Physician Quality
Reporting Program (PQRS)
Meaningful use (MU)
Value-based Modifier (VBM)
Physician Quality
Reporting Program (PQRS)
Meaningful use (MU)
Value-based Modifier (VBM)
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MIPS performance categories
30%
30%
15%
25%
Quality Measures Resource Use Clinical Practice Improvement Activities Meaningful Use
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MIPS – clinical practice improvement activities
Expanded Practice Access
Same day appointments for
urgent needs
After hours clinician advice
Population Management
Monitoring health conditions &
providing timely intervention
Participation in a qualified clinical data
registry
Care Coordination
Timely communication of
test results
Timely exchange of clinical information with patients AND
providers
Use of remote monitoring
Use of telehealth
Beneficiary Engagement
Establishing care plans for complex
patients
Beneficiary self-management assessment &
training
Employee shared decision making
Patient Safety Practice
Assessment
Use of clinical checklists
Use of surgical checklists
Assessments related to maintaining of
certification
Alternative Payment Models
Participation in an APM will also count
for CPIA
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MIPS payment adjustment
Source: CMS.gov (https://goo.gl/54ON3Y)
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MIPS eligible professionals (EPs):
2019 & 2020 (First two
years)
• Physicians
• Physician Assistants
• Certified Registered Nurse Anesthetists
• Nurse Practitioners
• Clinical Nurse Specialists
• Groups that include such professionals
2021+
• Secretary can add EPs described in 1848(k)(3)(B) to MIPS
Excluded from MIPS:
*MIPS does not apply to hospitals or facilities
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More on MIPS
• CMS is expected to:
– Offer timely (such as quarterly) confidential feedback reports to each MIPS EP starting July 1, 2017
– Provide information about items and services furnished to the EPs patients by other providers and suppliers for which payment is made under Medicare to each MIPS EP, beginning July 1, 2018
– Make information about the performance of MIPS EPs available on Physician Compare
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PATH 2: ELIGIBLE APMS
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Path 2: Eligible alternative payment models (APMs)
• Encourages expansion of APM options, especially specialists
• Qualifying participants:– Are not subject to MIPS – which means you will
not be subject to MU!
– Receive bonus payments
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Qualifying participants
APM participants
QPs
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APMs according to MACRA
APMs include:
CMS Innovation Center model
MSSP
Demonstration:
a) under the Health Care Quality Demonstration Program
or b) required by Federal Law
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Sample of expected eligible APMs
Physician Focused Payment Models (PFPMs)
PCMH
MSSP
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PFPM process
Submission of model proposals
Technical Advisory Committee review proposals, submit recommendations to
HHS Secretary
Secretary comments on CMS website, CMS considers
proposed model
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How will MACRA affect me?
Source: https://goo.gl/okDAPb
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Potential rewards
MIPS only
• MIPS adjustments
Partial APMs
• APM-specific rewards
• MIPS adjustments*
Eligible APMs
• APM-specific rewards
• 5% lump sum bonus
*The legislation is currently written such that these EPs will be subject to MIPS adjustments. This could change to optional in the final rule.
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ADDITIONAL RESOURCES
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Additional resources
MACRA Pathway infographichttp://goo.gl/NjicIb
MACRA Fact Sheethttp://goo.gl/D5Mc0A
CMS.gov MIPS & APMshttps://goo.gl/bhf8v5
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Acronyms
• CMS: Centers for Medicare & Medicaid Services• HHS: U.S. Department of Health & Human Services• MU: Meaningful Use• EP: Eligible Professional• MACRA: Medicare Access and CHIP Reauthorization Act of 2015• SGR: Sustainable Growth Rate• MIPS: Merit-based Incentive Payment System• PQRS: Physician Quality Reporting System• VBM: Value-based Modifier or Value-based Payment Modifier• APM: Alternative Payment Model• QP: Qualifying Participant• CPIA: Clinical Practice Improvement Activities• MSSP: Medicare Shared Savings Program• CMMI: Center for Medicare & Medicaid Innovation• ACO: Accountable Care Organization• PCMH: Patient Centered Medical Home• PFPM: Physician Focused Payment Model
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Contact information
• @AlexJGoulding
• https://www.linkedin.com/in/ajgoulding
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THANK YOU!