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PROPRIETARY & CONFIDENTIAL – © 2017 PREMIER, INC.1

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PROPRIETARY & CONFIDENTIAL – © 2017 PREMIER, INC.

MACRA – MIPS

How well prepared are your organizations?

STEPHANIE CRANE

Performance Partner, Premier Performance Partners

JESSICA SAFKO

MIPSWizard Product Manager


Today’s presentation will conclude with Q&A

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presentation, please submit it through the “Questions”

feature on the webcast menu.

We’ll address questions at the end of the presentation.


How well prepared is your organization?

Agenda

MACRA MIPS overview

MIPS categories

How can Premier help?


MACRA REFORM TIMELINE(MEDICARE ACCESS AND CHIP REAUTHORIZATION ACT OF 2015)

2015 2016 2017 2018 2019 2020 2021 2022 2023 2024 2025

Permanent repeal of SGR

Updates in physician payments

MIP

S

Tra

ck 2018

4%

2026

0.5% (7/2015-2019) 0% (2020-2025)

AA

PM

Tra

ck

Measurement period

Measurement period

2017

-3.0%

Advanced APM participating providers exempt from MIPS; receive annual 5% bonus (2019-2024)

Merit-Based Incentive Payment System (MIPS) adjustments

2019

+/-4%

2020

+/- 5%

2021

+/- 7%

2022 & beyond

+/- 9%

MIPS exceptional performance adjustment; ≤ 10% Medicare payment (2019-2024)

0.75% update

0.25% update

Measurement periodNon-Advanced APM participating in MIPS with enhanced scoring and reporting; Potential to move to AAPM

0.25% update

MIP

S

AP

M

Tra

ck

PQRS Pay for Reporting

Meaningful Use Penalty

Value-based Payment Modifier


MIPS reporting options for 2017

Do not submit

data for 2017

• Automatic -4% payment adjustment

Submit minimal

data for 2017

• 1 quality; 1 Improvement

Activities (IA); or 5

required Advancing Care

Information (ACI)

measures

Submit partial

data for 2017

• 1+ quality; 1+ IA;

• or 5+ required ACI

measures

• 90-day minimum

• Possible + adjustment

Submit full data

for 2017

• Full quality, IA, and ACI

• Full 90 days, ideally full

year

• Maximize + adjustment

Downward

Payment

Adjustment

Upward Payment Adjustment

(based on performance)

Zero

Payment

Adjustment


MIPS Eligible Clinicians

EXCLUSIONS

REVISED SCORING

MIPS 2019 Eligible Clinicians (ECs) = Physicians, PAs, NPs, CNSs, CRNAs

• Participation in a MIPS APM

• Small practices

• Rural practices, practices located in geographic health professional shortage areas

• Non-patient facing clinicians

• Hospital-based clinicians

• Low-volume threshold (applies at the reporting level)

• Advanced Alternative Payment Model Qualifying & Partially Qualifying participants.

• New Medicare-enrolled eligible clinicians.


What qualified as a MIPS APM?

Both:• E.g.

MSSP

Track

2/3 or

Next

Gen

Advanced APM(1) CEHRT participation.

(2) Payment based on

quality measures

comparable to MIPS.

(3) PCMH or greater than

nominal risk.

MIPS APM(1) CMS model.

(2) At least 1 MIPS

EC on the Participant

list.

(3) Financial

incentive based on

quality/cost

performance.

• E.g. MSSP Track 1

Alternative Payment Model (APM)

• E.g. CJR• E.g. BPCI

Some APMs do not qualify as a MIPS APM and/or Advanced APM.

• E.g. AHC• E.g. AIM

Note: Does not include all APMs.


Reporting considerations: Multiple methods

Report as individuals or

group?

What reporting vehicle?

1

Individual EC

Reporting

CEHRT QCDRAttestationQualified

Registry

Review MIPS 2019 ECs.

Group Reporting

Qualified

RegistryCEHRT

CMS

Web

InterfaceQCDR

Same reporting vehicle for all applicable MIPS categories?

2

3

AttestationClaims Claims



Improvement Activities

Select ~ 4 of 92 Improvement Activities across 8 subcategories

Expanded

Practice

Access

Beneficiary

Engagement

Population

Management

Achieving Health

Equity

Patient Safety

& Practice

Assessment

Emergency

Response &

Preparedness

• Current ACOs = full IA points

• Patient-Centered Medical Home = full IA points.

• APM participation = half IA points.

Care

Coordination

Integrated

Behavioral &

Mental Health



Advancing Care Information (ACI)

Report 4 or 5 Required ACI measures across 4 objectives for the ACI base score

Protect Patient

Health Info (PHI)

Health

information

exchange

Patient

electronic

access

Electronic

prescribing

* Public health

and clinical data

registry

reporting*

Coordination of

care through

Patient

engagement

* Additional points above the base

score’s 50 points for performance

in select measures – capped at

100 points *

* Electronic Clinical Quality

Measures (eCQMS) are no

longer required. *



Quality excluding MIPS APMs

CEHRT Bonus

(end-to-end

electronic reporting

requirements)

All-Cause

Hospital

Readmissions

(groups with 16

providers)

271 quality

measures

(1 outcome measure

required, bonus for

high

priority/outcome

measures)

Select 6 quality measures from 271 based on specialty/ability to report/type

All-Cause Hospital Readmissions automatically calculated from claims.



Quality for MIPS APMs: ACOs

MIPS ACO Quality category:

Scored on 11 measures. CEHRT bonus TBD.

14 GPRO

Quality measures

reported through

CMS Web Interface

CEHRT Bonus

(end-to-end

electronic reporting

requirements)

No separate All-

Cause Hospital

Readmissions from

claims like under

the VM.


How well prepared are your organizations?

2017 MIPS Composite Performance Score (CPS)

Performance

Category

Your Points

Awarded

Total

Possible

Points

Non-MIPS APMs’

2017 Category

Weighting

MIPS APM

ACO’s

2017 Category

Weighting

% of the

MIPS CPS

QUALITY X

60 – 70*

or

110

60% 50%X%

(X/70 * 60)

ADVANCING CARE

INFORMATIONX 100 25% 30%

X%

(X/100 * 25)

IMPROVEMENT

ACTIVITIESX 40 15% 20%

X%

(X/40 * 15)

COSTNot included in 2017

performance year for

non-MIPS APMs.

Never included in

MIPS APM CPS.

Total ~X%

* Readmission measure (10 points) only applies to groups with greater than 15 clinicians.


2017 Self-Service MIPS Reporting Solution

MIPSwizard


MIPSwizard – your solution for MIPS reporting

2017 MIPSwizard Reporting Options

• CMS Qualified Registry reporting for Individual Clinicians &

GPRO Practices

• Quality Payment Program Measures

• All MIPS Quality Measures Supported

• All Quality Payment Program Categories Supported

• Registry reporting available for Quality, Advancing Care Information,

and Improvement Activities


MIPSwizard Quality Reporting

Select Quality Measures

Collect & Load Data to your MIPSwizard

Patient Registry

Review Your Results in Real

Time

Submit your data for the

MIPS Program Year


MIPSwizard Measures Selection Process

• Search by Name

• Search by ID Number

Select from ANY MIPS Measure

• All Measures Sets Supported

• Guided selection process

View Measures by Specialty Set

• Find MIPS measures according to the codes billed during PY2017

View Measures by Billing Code


Self Service Data Entry Options

Add data to your patient registry at any frequency throughout

the 2017 reporting period!

Manual Data Entry

Guided Self Entry Tool

Online Questionnaires

Data Upload Tools

Data Templates and Definition Files

Measure Resources and Tools to help you collect data


Optional Reporting Modules: ACI & IA Attestations

New in 2017: Attestation Modules for the Advancing Care

Information and Improvement Activities MIPS Categories!

• Optional Modules

• Improvement Activities

• Attest to up to 4 improvement activities for at least 90 days in 2017

• Those groups with fewer than 15 participants or that are in a

rural/underserved area may need to attest to fewer activities

• Advancing Care Information

• Fulfill 5 required measures for at least 90 days

• Additional measures may be able to be submitted for additional credit!


Submit your MIPS Reporting Easily and Accurately

• Trusted Qualified Registry Solution for Quality

Reporting

• From the creators of the #1* PQRS Registry, the PQRSwizard

• Take advantage of

• Over a 99.5% success rate**

• Real-Time Data Validation

• Retrospective & Prospective Data Entry

• Performance Comparison to National Benchmarks

*Ranking based upon utilization, professional organization recommendations, and eligible provider success rates.

** >99.5% of eligible professionals that relied on PQRSwizard, submitted correct NPI/TINs, provided correct data, and received their incentive payment.


How Do I get Started?

MIPSwizard – Launching Summer 2017!

Add your information to

the MIPSwizard

Mailing List!

Questions?

Contact our team from

www.mipswizard.org!

Phone and Email

Support Available Now!

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