Greenway Health MACRA eBook

OTHERVISUALELEMENTS
Preparing
your practice
for MACRA

The Daunting Landscape
32% of those expenditures are
being spent in the hospital market,
where prices are significantly
higher than services in the
ambulatory market, which only
receives 20% of the spend2
Public payers such as Medicare,
Medicaid, and the VA pay for over
40% of all healthcare services2
Healthcare expenditures will
represent over 19% of GDP
by 20231
1
Kaiser Family Foundation calculations using NHE data from Centers for Medicare and Medicaid Services, Office of the Actuary,
National Health Statistics Group at http://www.cms.hhs.gov/NationalHealthExpendData/
2
Centers for Medicare & Medicaid Services, Office of the Actuary, National Health Statistics Group
Preparing your practice for MACRA 2

What is the Medicare and CHIP
Reauthorization Act of 2015?
MACRA was enacted to replace the Sustainable Growth
Rate (SGR), which was designed to ensure that growth in
per beneficiary Medicare expenditures did not exceed
GDP Growth.
• MACRA reauthorizes appropriations for Medicare Part B
(physician services) and CHIP. It only applies to Medicare Part B
• MACRA creates the Quality Payment Program, which is broken into
two tracks:
• Merit-based Incentive Program (MIPS)
• Advanced Alternative Payment Models

What Does MACRA Do?
MACRA was passed in 2015 to roll the following programs
into a single Quality Payment Program (QPP) that focuses
on quality, cost, and administrative simplification by
removing different reporting requirements.
• PQRS
• Meaningful Use
• Value-based Modifier
PQRS
Meaningful
Use
Value-based
Modifier
MACRA Quality
Payment Program

MIPS
MIPS is the default of the two programs. It
measures Eligible Clinicians on Quality, Cost,
Clinical Practice Improvement Activities, and
Advancing Care Information.
You are subject to MIPS if:
• You take enough Medicare revenue and/or see
enough Medicare patients; and,
• You are an “Eligible Clinician” (EC), meaning:
• Physicians (MD/DO and DMD/DDS), PAs,
NPs, clinical nurse specialists, certified
registered nurse anesthetists for years
one and two
• CMS may expand this to physical or
occupational therapists, speech-language
pathologists, audiologists, nurse midwives,
clinical social workers, clinical psychologists,
dietitians/nutritional professionals
• Even if you are an EC, you are not subject to
MIPS if it’s your first year accepting Medicare
or participating in an APM

Who is Eligible to Participate in MIPS?
YEARS 1 AND 2
Physicians (MD/DO and DMD/DDS), PAs,
NPs, clinical nurse specialists, certified
registered nurse anesthetists
YEARS 3+
Physical or occupational therapists,
speech-language pathologists,
audiologists, nurse midwives, clinical
social workers, clinical psychologists,
dietitians/nutritional professionals

Eligible Clinician Reporting
Eligible clinicians can participate in MIPS as an individual or group.
GROUP
A group, as defined by taxpayer
identification number (TIN),
would be assessed as a group
practice across all four MIPS
performance categories
VIRTUAL GROUP REPORTING
To be implemented in 2019
performance period where
multiple TINs with 10 ECs
or fewer may report as a
single entity
INDIVIDUAL
Preparing your practice for MACRA 7Preparing your practice for MACRA 7

Who Is Not Eligible to Participate
in MIPS?
MIPS does not apply to hospitals or facilities.
First year of Medicare
Part B participation
Below low patient
volume threshold
Certain participants
in Advanced APMs
Medicare billing charges
≤$90,000 OR providers
care for ≤200 patients in
one year

Most Clinicians Will Be Subject to MIPS
MIPS does not apply to hospitals or facilities.
Subject to MIPS
Not in APM In non-Advanced APM QP in Advanced APM
In Advanced APM,
but not a QP
Some people may be
in Advanced APMs
but not have enough
payments or patients

MIPS and Your Bottom Line
Two years after each performance period, you’ll
get a payment adjustment on your FFS claims.
• For the 2017 performance period, you’ll get
up to a positive or negative 4% adjustment
depending on your performance in 2019
• For the 2020 performance period and future
ones, you’ll get up to a positive or negative 9%
adjustment depending on your performance in
2022 onwards

Initial Years’ Exceptional
Performers Bonus
For the first six years of the program,
Congress has appropriated $500 million per
year for “exceptional performers.”
• These exceptional performers can earn up to
an additional 10% positive adjustment on their
claims (for example, for the 2017 performance
period, up to 14%)
• For the first two years of the program, to be
an exceptional performer you have to earn a
composite score of 70 or higher
• These funds are exempt from budget neutrality

MIPS at Maturity
Once the program is fully implemented, CMS will set a “performance threshold” each
year, comprised of the mean or median of all prior year MIPS scores.
This principal is called budget neutrality. The program is designed to not increase or decrease the
impacts on the federal budget.
CMS performance threshold
Exceed threshold – make money
Meet threshold – no impact
Fall below threshold – lose money

MIPS Scoring
MIPS measures in four categories, which collectively create a composite score of 100:
QUALITY
replaces the Physician Quality
Reporting System (PQRS) and will
represent 30% of your total score
after full implementation (2019)
ADVANCING CARE
replaces Meaningful Use, measures
how providers use technology
and represents 25% of your
composite score
COST
replaces the Value-based Modifier
and measures healthcare
expenditures per patient, will
represent 30% of your score after full
implementation (2019)
IMPROVEMENT ACTIVITIES
measures clinical process
improvements, representing 15%
of your MIPS composite score

Quality Quality
Quality
Cost
Cost
60% 50%
30%
10%
30%
15%
15%
15%
25% 25%
25%
Advancing Care
Information
Advancing Care
Information
Advancing Care
Information
Clinical Practice
Improvement Activities
Clinical Practice
Clinical Practice
2017
CATEGORY
WEIGHTS
2018
CATEGORY
WEIGHTS
2019
CATEGORY
WEIGHTS

MIPS Categories: Quality
• While Quality represents 30% of the
composite score, you earn up to 60
points within Quality (10 per measure)
• If you are in the top decile on a measure,
you’ll get 10 points, the next decile will
get nine points, and so on
• The floor is three points for most
measures (so even if you’re in the
bottom decile you’ll get three points
instead of one)
• Reporting is accomplished by claims,
QCDR, qualified registry, or through an
EHR depending on the measure
Quality
Cost
30%
30%
15%
25%
Advancing Care
Information
Clinical Practice
2019
CATEGORY
WEIGHTS

MIPS Categories: Cost
• It will include the Medicare Spending
Per Beneficiary (MSPB), which is a per
capita measure of overall spending
• Going forward, CMS will introduce new
episode-based measures that assess
cost for certain events, like a heart
attack
• Reporting is done by CMS on the back-
end through claims
Quality
Cost
30%
30%
15%
25%
Advancing Care
Information
Clinical Practice
2019
CATEGORY
WEIGHTS

MIPS Categories: Advancing
Care Information
• Within Advancing Care Information
(ACI), you can earn up to 100 points
• 50 points comes from your base
score. There are 4-5 base measures
that require you to complete an activity
at least one time for one patient
• If you do not meet your base measures
you will fail the entire category
• Base measures include:
• Electronic Prescribing
• Health Information Exchange
(sending and receiving summaries
of care)
• Providing patients with electronic
access to their health record
• Security Risk Analysis
Quality
Cost
30%
30%
15%
25%
Advancing Care
Information
Clinical Practice
2019
CATEGORY
WEIGHTS

Advancing Care Information (Cont’d)
• The remaining 50 points comes from
your performance score and bonus score
• Essentially, the more you do, the more
you earn. For example, one performance
measure is “View, Download, Transmit.” If
1/10 patients view their electronic health
record, you will get one point to your ACI
score. If 2/10 do, you’ll get two points, all
the way up to 10
• You can also get a bonus score. You
get more points for connecting to
public health registries, immunization
registries, and for using CEHRT to report
improvement activities
Quality
Cost
30%
30%
15%
25%
Advancing Care
Information
Clinical Practice
2019
CATEGORY
WEIGHTS

ACI Measures – 2017
Objective Measure Required Performance
Protect Patient Health Information Security Risk Analysis Y 0
Electronic Prescribing e-Prescribing Y 0
Patient Electronic Access
Provide Patient Access Y Up to 20%
View, Download or Transmit (VDT) N Up to 10%
Patient-Specific Education Patient-Specific Education N Up to 10%
Secure Messaging Secure Messaging N Up to 10%
Health Information Exchange Health Information Exchange Y Up to 20%
Medication Reconciliation Medication Reconciliation N Up to 10%
Public Health and Clinical Data
Registry Reporting
Immunization Registry Reporting N 0 or 10%
Syndromic Surveillance Reporting N
Up to 5% bonus per measure,
15% maximum bonus allowed
Specialized Registry Reporting N

ACI Measures – 2018 onward
Objective Measure Required Performance
Protect Patient Health Information Security Risk Analysis Y 0
Electronic Prescribing e-Prescribing Y 0
Patient Electronic Access
Provide Patient Access Y Up to 10%
Patient-Specific Education N Up to 10%
Coordination of Care Through
Patient Engagement
View, Download or Transmit (VDT) N Up to 10%
Secure Messaging N Up to 10%
Patient-generated health data N Up to 10%
Health Information Exchange
Send a Summary of Care Y Up to 10%
Request/Accept Summary of Care Y Up to 10%
Clinical Information Reconciliation N Up to 10%
Public Health and Clinical Data
Registry Reporting
Immunization Registry Reporting N 0 or 10%
Syndromic Surveillance Reporting N
Up to 5% bonus per measure, 15%
maximum bonus allowed
Electronic Case Reporting N
Public Health Registry Reporting N
Clinical Data Registry Reporting N

Essentially, the more you do, the more you
earn. For example, one performance measure
is “View, Download, Transmit.” If 1/10 patients
view their electronic health record, you will get
one point to your ACI score. If 2/10 do, you’ll get
two points, all the way up to 10.
Don’t forget that you can also get a bonus
score. You get more points for connecting to
public health registries, immunization
registries, and for using CEHRT to report
improvement activities.
Maximizing ACI

MIPS Categories – Clinical Process
Within this category, you can earn up to 40 points. If you are a small practice, defined as having 15
ECs or fewer, you only need 20 points.
Some activities are high-weighted, others are medium-weighted. High-weighted activities are
worth 20 points. Medium-weighted activities are worth 10 points.
Some examples of activities:
Providing patients with 24/7 access to their care team
Chronic care and preventative care management for empaneled patients
Engagement of patients through implementation of improvements in patient portal
Collection and follow-up on patient experience and satisfaction data on beneficiary engagement
Engagement of patients, family and caregivers in developing a plan of care
Becoming a recognized Patient-centered Medical Home (automatic 100%)

Compare
Learn
Design
LEARN ABOUT THE PROGRAM
Learn what it means for your bottom line,
and what’s coming in the future. Visit qpp.
cms.gov and Greenway Health webinars for
more information.
COMPARE YOUR DATA
Look at your historical data and measures,
and focus on what you’re good at, what’s
relevant to your patient population, and where
you can make the easiest improvements.
DESIGN A PLAN
Design a plan based on your data that
accounts for 2017 and 2018. Use the
transition year to test your plan. Don’t slack
this year or 2018 might catch you off-guard.
Don’t take the transition year off, instead prepare for success
How to Succeed with MACRA

Compare
Learn
Design
COMPARE YOUR DATA
Look at your historical data and measures,
and focus on what you’re good at, what’s
relevant to your patient population, and where
you can make the easiest improvements.
Don’t take the transition year off, instead prepare for success
How to Succeed with MACRA
LEARN ABOUT THE PROGRAM
Learn what it means for your bottom line,
and what’s coming in the future. Visit qpp.
cms.gov and Greenway Health webinars for
more information.
DESIGN A PLAN
Design a plan based on your data that
accounts for 2017 and 2018. Use the
transition year to test your plan. Don’t slack
this year or 2018 might catch you off-guard.

OTHERVISUALELEMENTS
Provider
Strategies
for MIPS

If you are eligible, start learning about the program.
Read the executive summary
Talks with your doctors to establish financial, clinical,
and performance goals
Do you want to simply comply and avoid penalties?
Do you want to test your systems and gradually improve over time?
Do you want to be a high performer?
Determine what workflow and process changes might be required
to meet your performance goals

Getting Started

2017 Compliance/Penalty Avoidance
Failure to participate results in a 4% negative adjustment rate.
To simply avoid a penalty (reach three points):
Read the executive summary
Start collecting data on–
1. One CQM;
2. One improvement activity; or,
3. The required ACI measures

2017 High Performance
(scores exceeding 70)
It is strongly recommended that you upgrade to 2015 CEHRT
to add a bonus to your composite score.
Choose and start collecting data on:
Six quality measures
• Analyze prior years’ CQM performance to determine
what your practice is good at
• One outcomes measure or another high priority
measure if outcomes is unavailable
• Attempt to come in at least in the 4th decile across
all your quality measures
• Visit this page to download measure specifications
and what scores place you in what deciles

2017 Test Your Systems
(scores from 3–70)
It is strongly recommended that you upgrade to a 2015 Certified EHR Technology (CEHRT) to add
a bonus to your composite score.
• Analyze prior years’ CQM performance to determine what your practice is good at
• One outcomes measure or another high priority measure if outcomes is unavailable
• Attempt to come in at least in the 4th decile across all your quality measures
• Visit this page to download measure specifications and what scores place you
in what deciles
Collect data on the required ACI measures
• Pick several to excel at and implement process changes at the clinician level so
technology is consistently used to ensure you reach the maximum ACI score
Choose 1-4 improvement activities depending on practice size and priority weights
(get to 40 points)
Conduct workflow analyses across the organization on all measures to ensure data is being
captured on a quarterly basis.
Really look at full year reporting to make sure your organization is prepared and has staff
capacity to do this year after year.

2018 Compliance/
Penalty Avoidance
Determine a pathway to 15 composite points.
Sample reporting options:
Start collecting data on–
• Six CQMs
• Full improvement activity participation; or,
• The required ACI measures and one CQM

2018 Test Your Systems
(scores from 15-70)
It is strongly recommended that you upgrade to a 2015 Certified
EHR Technology (CEHRT) to add a bonus to your composite score.
• One outcomes measure or another high priority measure
if outcomes is unavailable
• Attempt to come in at least in the 4th decile across
all your quality measures. Visit this page to download
measure specifications and what scores place you in
what deciles
.
Collect data on the required ACI measures, and pick a couple
you really want to hone in on and excel at (workflow dependent); and,
Choose 1-4 improvement activities (get to 40 points)
Conduct workflow analyses across the organization on all
measures to ensure data is being captured on a quarterly basis.

2018 High Performance
(scores exceeding 70)
It is strongly recommended that you upgrade to a 2015 Certified EHR
Technology (CEHRT) to add a bonus to your composite score.
• Analyze prior years’ CQM performance to determine what
your practice is good at
• One outcomes measure or another high priority measure if
outcomes is unavailable
• Attempt to come in at least in the 4th decile across all
your quality measures
• Visit this page to download measure specifications
and what scores place youin what deciles
• Consider trying to improve on a prior year’s CQM to
take advantage of improvement scoring under MIPS

2018 High Performance (cont’d)
Collect data on the required ACI measures
• Pick several at which to excel; implement process changes at the clinician level and use
technology consistently to ensure you reach the maximum ACI score
Choose 1-4 improvement activities depending on practice size and priority weights
(get to 40 points)
Conduct workflow analyses across the organization on all measures to ensure data is being
captured on a quarterly basis
Participate in full year reporting to prepare for the eventual transition to an Advanced APM.
Begin evaluating what Advanced APMs are available to you in 2019 and beyond, whether through
Medicare, Medicaid, or the All-Payer Option; determine on whether it makes sense to participate
based on:
• Process readiness
• Clinician culture
• Financial performance under MIPS
• Alignment with other programs/initiatives in your payer mix

2019?
Cost and resource use will be measured at 30% of your MIPS score
• 2019 episode-based measures have not been determined, so subscribe for updates at
qpp.cms.gov
• The Medicare spending per beneficiary measure will likely be included
• Review prior Quality and Resource Use Reports (QRUR) to assess current levels
of performance
The MIPS performance threshold will be set at the mean or median of prior years’ MIPS
composite scores
This means each year the performance threshold will increase
As the program becomes more aggressive, consider Advanced APMs; Determine whether it
makes sense to participate based on:
• Process readiness
• Clinician culture
• Financial performance under MIPS
• Alignment with other programs/initiatives in your payer mix

Greenway Health: A Record of Success
in Value-based Care
Exclusive to the ambulatory market, Greenway Health has specialized in
serving independent practices for over 40 years.
We have over 17,000 meaningful use attestations, and over 80% of our
participating clients have made money or avoided negative adjustment in
MU 1, MU 2, and MU 3.
Over 90% of our participating clients made money or avoided a negative
adjustment in ACO or PCMH.

Simplifying MACRA Participation
Minimize confusion and disruption as you tackle
MACRA and MIPS challenges. [CTA HERE]
Greenway Health’s systems can help simplify meeting and exceeding minimum MIPS requirements.
Install Greenway Health’s 2015 CEHRT edition and add 2.5 points to your composite score
Report the base ACI measures, which requires only a one in the numerator, for 12.5 points
Use Greenway Health’s EHR to report on 6 quality measures, meet the data submission criteria,
and you get 15 points (the minimum is 2.5 points per measure)
Greenway supports all 53 EHR-based measures through Intergy and Intergy Practice Analytics.
Because that qualifies as electronic reporting, it brings you to 20 points
Just meeting the reporting requirements with our systems gets you 35 points when the threshold
for next year is 15.

Greenway Health MACRA eBook

Recommandé

Recommandé

Contenu connexe

Tendances

Tendances (20)

Similaire à Greenway Health MACRA eBook

Similaire à Greenway Health MACRA eBook (20)

Plus de Ideba

Plus de Ideba (20)

Dernier

Dernier (20)

Greenway Health MACRA eBook