The Medicare Access and CHIP Reauthorization Act of 2015 ...
The Medicare Access and CHIP Reauthorization...
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1 The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Karen Southard, RN, MHA State Director – SC Atlantic Quality Innovation Network/QIO Atlantic Quality Innovation Network (AQIN) The federally funded Medicare Quality Innovation Network – Quality Improvement Organization (QIN-QIO) for New York State, the District of Columbia, and South Carolina. Partners - The Carolinas Center for Medical Excellence in South Carolina, IPRO in New York, and Delmarva Foundation in the District of Columbia. One of 14 QIN-QIOs operating across the U.S. Five-year QIN-QIO contract with CMS known as the 11 th statement of work (SOW) 2 Atlantic Quality Innovation Network (AQIN) Works toward better care, healthier people and communities, and smarter spending Catalyzes change through a data-driven approach to improving healthcare quality. Collaborates with providers, practitioners and stakeholders at the community level to share knowledge, spread best practices and improve care coordination. Promotes a patient-centered model of care, in which healthcare services are tailored to meet the needs of patients. 3
Transcript of The Medicare Access and CHIP Reauthorization...
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The Medicare Access and CHIPReauthorization Act of 2015 (MACRA)
Karen Southard, RN, MHA
State Director – SC Atlantic Quality Innovation Network/QIO
Atlantic Quality Innovation Network (AQIN)
The federally funded Medicare Quality Innovation Network –
Quality Improvement Organization (QIN-QIO) for New York State,
the District of Columbia, and South Carolina.
Partners -
The Carolinas Center for Medical Excellence in South Carolina,
IPRO in New York, and
Delmarva Foundation in the District of Columbia.
One of 14 QIN-QIOs operating across the U.S.
Five-year QIN-QIO contract with CMS known as the 11th statement
of work (SOW)
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Atlantic Quality Innovation Network (AQIN)
Works toward better care, healthier people and communities, and
smarter spending
Catalyzes change through a data-driven approach to improving
healthcare quality.
Collaborates with providers, practitioners and stakeholders at the
community level to share knowledge, spread best practices and
improve care coordination.
Promotes a patient-centered model of care, in which healthcare
services are tailored to meet the needs of patients.
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MACRA
The Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) is a bipartisan legislation signed into law
on April 16, 2015.
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What does MACRA do?
• Repeals 1997 Sustainable Growth Rate Physician Fee
Schedule (PFS)
• 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
“advanced” alternative payment models (APMs)
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Medicare Reporting 2016
Currently there are multiple quality and value reporting
programs for Medicare clinicians:
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Key Changes from Current PQRS Program
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Reporting PQRS 2016
Hospital and Palliative Care have one registry option:
9 PQRS Measures across 3 domains
or
< 9 measures, not covering 3 domains, provider needs
to pass the Measure- Applicability Validation (MAV)
CMS will perform a review of claims submitted to
determine if the provider could have
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Two Options for Reimbursement Under MACRA
The Quality Measurement Development Plan (MDP) –
Strategic Framework
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CMS Strategic Approach
Priorities Set:
Multi-stakeholder group
Public comments
Analysis of PQRS
preferred measure sets
by specialty
Key Topics:
Shared decision making
Personal preferences
Misdiagnosis/accuracy
Medication safety
Team-based care
Clinical outcomes
Early detection of
chronic disease
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Measurement Development Plan Cycle
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Draft of MDP
published for
comments
Jan. 2016 Comment period ends
Mar. 2016
Final MDP published
May 2016
Call for Measure
Ends
June 2016
Final Rule
Nov. 2016
MIPS Begins
Jan. 2017
MIPs Payment Adjustment
Begins
Jan. 2019
CMS Key Priorities
• Follow the patient across the continuum of care for
populations with one or more chronic conditions
• Provider/patient choice and treatment goal matter
• Support physical and behavioral health integration
• Population outcome measures
• Patient experience of care
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Who will participate in MIPS?
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Who will not participate in MIPS?
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MIPS: Eligible Clinicians
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Note: Most Practitioners Will Report Under MIPS
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What are Alternate Payment Models (APMs)?
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Proposed Rule Advanced APMs List
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https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-
Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
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Merit-based Incentive Payment System (MIPS)
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MIPS – Medicare Reporting 2017
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Year 1 Performance Category Weights for MIPS
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Performance Category
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Data Submission for MIPS
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Composite Performance Score (CPS)
Key Changes Advancing Care Information (Medicare MU)
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Performance Category Scoring
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Calculating the Composite Performance Score (CPS) for MIPS
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Payment Adjustment Under MIPS
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MIPS: Scaling Factor Example
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MIPS: PROPOSED RULE Timeline
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Preparing for MIPS
• Participate in Current CMS Quality Programs (PQRS,
VM, MU)
• Review your QRUR
• QIO
• PCMH
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Resources
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https://www.cms.gov/Medicare/Quality-Initiatives-
Patient-Assessment-Instruments/Value-Based-
Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-
APMs.html
Quality Improvement Organizations
Karen Southard
AQIN-SC
919-461-5663
Atlantic Quality Innovation Network
The Carolinas Center for Medical Excellence
12040 Regency Parkway, Suite 100
Cary, NC 27518
919.461.5500
www.atlanticquality.org
Linda Kluge
Alliant Quality-NC
678-527-3675
Template 9/23/14
2016 PQRS Measures Relevant to Hospice and Palliative Care
Hospice and Palliative Care providers have one registry option for reporting PQRS:
1. 9 PQRS measures across 3 domains or if less than 9 measures, a provider will need to pass the
MAV. To pass the MAV, the provider needs to make sure that if a measure belongs to a PQRS
cluster, all other measures inside that cluster are also reported. For example, when reporting
measure #131, the provider also needs to report measure #143 and #144 (Oncology Pain Care
Cluster). In addition, a cross‐cutting measure, if applicable, must be reported in order for a
provider to pass the MAV) Some examples of measures (with domain names):
o #46 Medication Reconciliation (cross‐cutting measure) ‐ Communication and Care
Coordination
o #47 Advance Care Plan (Palliative Care Cluster) (cross‐cutting measure) ‐
Communication and Care Coordination
o #48 Urinary Incontinence: Assessment of Presence or Absence of Urinary Incontinence
in Women Aged 65 Years and Older (Urinary Incontinence Care Cluster) ‐ Effective
Clinical Care
o #50 Urinary Incontinence: Plan of Care for Urinary Incontinence in Women Aged 65
Years and Older (Urinary Incontinence Care Cluster) (cross‐cutting measure) ‐ Person
and Caregiver‐Centered Experience and Outcomes
o #130 Documentation of Current Medications in the Medical Record (cross‐cutting
measure) ‐ Patient Safety Note: This measure is counted for every Medicare patient visit
vs. once per reporting period.
o #131 Pain Assessment and Follow‐Up (Oncology Pain Care Cluster) (cross‐cutting
measure) ‐ Communication and Care Coordination Note: This measure is counted for
every Medicare patient visit vs. once per reporting period.
o #134 Preventive Care and Screening: Screening for Clinical Depression and Follow‐Up
Plan (Palliative Care Cluster) (cross‐cutting measure)‐ Community/Population Health
o #143 Oncology: Medical and Radiation – Pain Intensity Quantified (Oncology Pain Care
Cluster) ‐ Person and Caregiver‐Centered Experience and Outcomes
o #144 Oncology: Medical and Radiation – Plan of Care for Pain (Oncology Pain Care
Cluster) ‐ Person and Caregiver‐Centered Experience and Outcomes
o #154 Falls: Risk Assessment (Falls Care Cluster) (cross‐cutting measure) ‐ Patient Safety
o #155 Falls: Plan of Care (Falls Care Cluster) (cross‐cutting measure) ‐ Communication
and Care Coordination
o #342 Pain Brought Under Control within 48 Hours (Palliative Care Cluster) ‐ Person and
Caregiver‐Centered Experience and Outcomes
o #386 Amyotrophic Lateral Sclerosis (ALS) Patient Care Preferences ‐ Person and
Caregiver‐Centered Experience and Outcomes
o #403 Adult Kidney Disease: Referral to Hospice ‐ Person and Caregiver‐Centered
Experience and Outcomes
o Additionally at least one cross‐cutting measure must be satisfactorily reported by
individual providers or group practices with face‐to‐face encounters.
For more information please contact: Angela McCrea, Quality Improvement Specialist
[email protected], 803‐212‐7572
