Inside MACRA: The MIPS track explained Presented by: Kelly Whittle, Whittle Advisors

May 17, 2017

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Today’s industry expert

Kelly Whittle Kelly is a passionate strategist and expert in change leadership.

As the founder of Whittle Advisors, she shares client successes through international speaking engagements and publications. Her experience includes expertise in strategy, change leadership, and solution implementation for hospitals, physician practices, and specialty groups.

With 20 years of leadership experience, she specializes in developing business strategies based on data-driven evidence. Her clients have been recognized nationally for outstanding ICD-10 Transition achievements. She is a founder of the International Society of Digital Medicine, which is focused on international collaboration to improve healthcare outcomes through the use of technology.

Question 1: What are the primary differences between MIPS and APM?

The MIPS (Merit Based Incentive Program) was designed for providers that care for traditional medicare beneficiaries. It offers them an opportunity to earn bonuses and penalties, they can report as individuals or groups, gives them maximum flexibility in picking their pace, etc. APMS (Advanced Alternative Payment Models) provide the option to earn a 5% Medicare incentive payment for participating in an innovative payment model. They have a defined framework and carry +/- $ risk. Providers can report as individuals or groups, etc.

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MACRA

MIPS APM

aAPM

MIPS APM

Question 2: What are the four MIPS categories?

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60% of 2017 score 6/271+ quality measures

1 must be outcome measure or high priority measure

0% of 2017 score Assessed on claims data

10 episodes of care will set baseline; each episode is worth

10 points

15% of 2017 score Attest to improvement of

clinical practice. Choose 4 out of 90+ activities under 9

categories

25% of 2017 score Patient engagement & exchange of info EMR

2 measure sets based on 2014 or 2015 EMR certification

Note: Data pertain to MIPS categories for 2017

Question 3: How will MIPS be used to determine payment adjustments?

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60% of score Points earned + any

bonus points / max # of points

0% of score Points for score measures

/ 10 x [# of score measures]

Max 100 points

15% of score [Total # pts scored / total max # points (40)] x 100

25% of score [Base] + [Performance] +

[Bonus]

Question 3: How will MIPS be used to determine payment adjustments?

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Question 4: In what formats can MIPS eligible clinicians submit data in 2017?

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Use a single data submission method for reporting all performance categories (Quality, ACI, and IA, to CMS. MIPS allows the following reporting methods: • Qualified Registry • EHR • Qualified Clinical Data Registry (QCDR) • Claims

Submission Mechanism

Number of quality measures supported

Claims 74

EHR 53

Qualified Registry/QCDR 243

CMS Web Interface 15

Question 5: Is there a clear benefit to either APM or MIPS, if eligible?

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

Questions & Answers

“Sometimes the questions are complicated and the answers are simple.” ― Dr. Seuss

Contact Information

Kelly Whittle 1.586.201.4882 @whittleadvisors WhittleAdvisors.com kelly@whittleadvisors.com

CONFIDENTIAL – Do not copy or distribute

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