See what's coming. The Medicare Access and CHIP Reauthorization Act ... Streamlines PQRS, VM and MU programs to work as
MACRA MINUTE See what’s coming. The Medicare Access and CHIP Reauthorization Act (MACRA) was designed to tie more payments to value, while simplifying reporting for physicians. MACRA timing 2016
2017
2018
Final ruling due by end of 2016
First performance year is 2017
2019 Impacts payments in 2019
(full year rather than 90 days)
MERIT-BASED INCENTIVE PAYMENT SYSTEM
MIPS
Most physicians will begin payment through this modified fee-for-service model. Streamlines PQRS, VM and MU programs to work as one, more flexible program. New component promotes and rewards practice improvement and innovation.
Two tracks for physician payment
ELIGIBLE ADVANCED ALTERNATIVE PAYMENT MODEL Annual bonus payment is available for physicians participating in payment models specifically approved by the Centers for Medicare & Medicaid Services (CMS).
APM
There are currently multiple individual
Physician Quality Reporting Program (PQRS)
quality and value programs for Medicare physicians and practitioners.
Medicare EHR Incentive Program
Value-based payment modifier
MACRA streamlines these programs into MIPS
Merit-based Incentive Payment System (MIPS) “The Medicare Access & Chip Reauthorization Act of 2015: Path to Value” Centers for Medicare & Medicaid Services
MIPS Composite Performance Score categories
Quality
50%
+
Advanced Care Information
+
25%
Clinical Practice Improvement Activities
Resource Use
+
MSSP Track 1 ACO
Payment adjustments
providers in MIPS qualify for preferential scoring, which could positively affect reimbursement.
=
10%
15%
Physicians and groups with Composite Performance Scores that fall above a threshold will receive bonuses. Those that fall below the threshold will face penalties.
Composite Performance Score (CPS)
Scores are public
Consumers will be able to view and compare scores on the CMS website.
“The Medicare Access & Chip Reauthorization Act of 2015: Path to Value” Centers for Medicare & Medicaid Services
Advanced APMS Payments based on MIPS-like quality measures
+
Quality measures:
Certified EHRT
+
CEHRT:
Minimum payment or patient threshold
+
Nominal risk:
50% of participants must use in 2017, 75% in 2018
Must be comparable to MIPS (e.g., have an outcome measure)
More than nominal risk
4% of expected expenditures; Marginal risk of 30%; Minimum loss ratio capped at 4%
Advanced APM and 5% bonus
=
Payments:
25% of all Medicare payments: Increases to 75% by 2024
Payment thresholds:
20% of all Medicare patients: Increases to 50% by 2024
“The Medicare Access & Chip Reauthorization Act of 2015: Path to Value” Centers for Medicare & Medicaid Services
What are my options? Am I an APM?
Am I an Advanced APM?
YES
NO
Do I have enough payments or patients through my Advanced APM? YES
Is this my first year in Medicare OR am I below the low-volume threshold?
YES
YES
NO
FAVORABLE MIPS SCORING AND ADVANCED APM SPECIFIC REWARDS
Not subject to MIPS
NO
Subject to MIPS
NO
Qualified Advanced APM Participant (QP) • Excluded from MIPS • 5% lump-sum bonus payment (2019–2024) • APM Specific rewards
Bottom line: There will be financial incentives for participating in an Advanced APM, even if you don’t become a QP.
“The Medicare Access & Chip Reauthorization Act of 2015: Path to Value” Centers for Medicare & Medicaid Services
CareAllies can help you maximize your reimbursements. We partner with you to assess your readiness and provide performance projections, conduct market opportunity assessments and can even support you with a comprehensive MACRA program strategy and operating model based on your organization’s needs. Just ask.
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