This document provides an overview of a presentation on navigating value-based reimbursement. The presentation covers MACRA regulations, readiness for MACRA, the significance of MACRA, leveraging technology, promoting interoperability, provider performance dashboards, additional dashboard benefits, healthcare and technology, and a wrap up. Key points include how MACRA replaced previous Medicare reimbursement with pay for performance, its two participation paths of MIPS and APMs, and how technology will be important for population health and meeting MACRA requirements through tools like provider performance dashboards.

1. NAVIGATING THE VALUE-BASED
REIMBURSEMENT WORLD
WWW.CITRINCOOPERMAN.COM
PROVIDER
PERFORMANCE
DASHBOARDS
KIERAN HIGGINS
Supervisor
215.545.4800 x4146
khiggins@citrincooperman.com

2. MEETING AGENDA
SECTION 1
SECTION 2
SECTION 3
SECTION 4
SECTION 5
SECTION 6
MACRA
Overview
MACRA
Readiness
MACRA
Significance
Leveraging
Technology for
Practice
Enhancement
Promoting
Interoperability
Provider
Performance
Dashboard
SECTION 7
SECTION 8
SECTION 9
Additional
Dashboards and
Benefits
Healthcare and
Technology
Wrap Up

3. The Medicare Access & CHIP
Reauthorization Act of 2015
MACRA Overview
• Replaced the previous Medicare
reimbursement schedule with a new pay-for-
performance program
• Focused on quality and accountability in patient
care
• January 1, 2017, eligible Medicare Part B
providers entered into a new payment
framework called the Quality Payment
Program (QPP)
• QPP has two paths for participation
• Merit-based Incentive Payment System (MIPS)
• Alternative Payment Models (APMs)
• Advanced Alternative Payment Models

4. How would you rank your current understanding of MACRA?
A. Never heard of it….
B. Low
C. Good Enough…
D. Expert
POLLING QUESTION

5. MACRA Readiness
Advanced APM Examples
• Bundled Payments for Care Improvement Advanced Model (BPCI Advanced)
• Comprehensive Primary Care Plus (CPC+)
• Medicare Accountable Care Organization (ACO) Track 1+ Model
• Next Generation ACO Model
• Medicare Shared Savings Program - Track 2
• Medicare Shared Savings Program - Track 3
MIPS Year 1 and Year 2 Key Differences
Year 1 Year 2
Reporting Requirements
Offered a Pick Your Pace Option
Test the Quality Payment Program
Submit data for one quality measure or one
improvement activity or all promoting interoperability
base score measures, for one patient, once. Avoid a
negative payment adjustment on 2019 claims.
Participate for a Partial Year
Submit data in all three categories with at least 50%
data completeness for 90 or more consecutive days.
Become eligible for a small positive adjustment on 2019
claims.
Participate for a Full Year
Submit data in all three categories with at least 50%
data completeness for a full calendar year. Become
eligible for a moderate positive adjustment on 2019
claims.
Must report for a full calendar year
Quality
Report on 6 measures, with at least one outcome
measure
Promoting Interoperability
Report all 4 Base measures and choose from 7
Performance measures
Improvement Activities
Report up to 4 measures
Cost (new category)
No data to report. Calculated based on Medicare
Spending per Beneficiary and total per capita cost
measures

6. MACRA Significance
• Reimbursement will be paid based on the outcome of the
care provided
• Organizations (Providers) need to know what is happening
across the continuum of care for every patient
• Shifting the landscape from volume based to value based
• Providers will be reliant on fast and accurate data to
effectively manage patient care
• Triple Aim
1. Improving the patient experience of care (Quality-
Satisfaction)
2. Improving the health of populations
3. Reducing the per capita cost of health care
What does this all mean?

7. • MIPS is designed to tie payments to quality and cost efficient care, drive improvement in care processes and
health outcomes, increase the use of healthcare information, and reduce the cost of care
• APMs are designed as a payment approach that gives added incentive payments to provide high-quality and
cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population
• The best way to be successful in MACRA or other value based programs is to use technology to your advantage
• Technology will be the main driver of Population Health and MACRA adherence
Leveraging technology for practice enhancement

8. Goals of the Promoting
Interoperability Category
• Promote Patient Engagement
• Promote the electronic exchange of
health information using Certified
Electronic Health Record
Technology (CEHRT)
Promoting Interoperability
Base Score
Performance
Score
Bonus Score
Promoting
Interoperability
Performance
Category
Score

9. Is Your Current Technology
Supporting Your Goals?
• Are you using Certified EHR Technology (CEHRT)?
• Is your CEHRT certified to the 2014 or 2015
edition?
• This impacts the choice of measure set
• Is your EHR vendor working with your practice to
implement necessary changes to workflow?
• Does your EHR accurately capture what you are
doing to care for your patients related to these
measures?
• Does your EHR make it easy to access the
information you need to meet the requirements?
• Do you have the necessary patient engagement
tools in place?
Promoting Interoperability

10. Navigating the Value-
Based Reimbursement
World
Provider
Performance
Dashboard

11. Does your organization (or your clients) have a current process in place to
track quality and productivity?
A. Of course!
B. Sort of
C. Not Really
D. None at all
POLLING QUESTION

12. CONTINUED
• Customized performance
dashboard circulated to each
provider on a monthly basis
• wRVU target tied to contract
requirements
• Estimated number of visits
needed to meet monthly wRVU
target
• Average wRVU per patient visit
• Provider patient visits compared
against entire practice and CMS
average
Provider Performance
Dashboard
Jan 2018
Feb 12 2018

13. CONTINUED
• Note locking tied to
predetermined quality standard
which could be tied to contract
(drive better RCM)
• Select quality metrics annually
which correlate with MIPs or other
value-based incentive program
standards
• Quality metric performance is tied
to EMR registry or preexisting
vendor reports
Provider Performance
Dashboard
Jan 2018

14. CONTINUED
Provider Performance
Dashboard
• Detailed report on all patient visits
during current month and year to
date
• Provider has a high level view of
the type of visits and procedures
they have conducted on a month
to month basis to drive
productivity
Jan 2018

15. Additional Dashboards
Other examples of dashboards we assisted our clients with.
• Admissions and readmissions
• Days of Service Outstanding
• Aging Buckets
• Daily cash balance and cash collections
• Daily census
• Payment Lag
• Gross revenue and payer mix of revenue
• HCAHPs
• Length of stay by service line
• Maximum debt service coverage ratio
• Observation stays
• Occupancy by service line
• Operating margin
• Patient populations that drive costs the most
• Staff overtime
• Surgeries
• Unrestricted days cash on hand

16. Benefits of a Dashboard
Operational Efficiency
• Dashboards can be designed to be flexible and configurable for the unique needs of any healthcare organization and can be
adapted to include the monitoring of specific time-limited priorities
• By highlighting areas in which the organization is underperforming, dashboards let managers monitor labor productivity, drill
down into details to identify root causes of poor performance and support performance improvement initiatives
• Dashboards facilitate the consolidation of data into a central location, thereby promoting data interaction and shortening the
data capturing, provisioning and analyzing processes for future initiatives
• Healthcare dashboards provide the capability to access more detailed information about key performance indicators and
other key measures while identifying common variables from that data to draw new and previously unseen connections
• Dashboards ensure greater transparency, highlight benefits of change initiatives and allow us to identify common variables
from the data to draw new and previously unseen connections

17. We understand your challenges and are focused on meeting your
needs. Our team is well-equipped to support your growth and vision.
Common Health care Scenarios:
• Your practice has outgrown its current IT
system or IT solution provider
• Your practice is moving into a new facility
• Your practice is merging and facing IT
integration issues
• Your practice is having trouble adapting to
recent regulatory changes (like MIPS) that
require enhanced IT capabilities
• Your practice is having difficulty implementing
and benefiting from the software that it
purchased
• Your revenue is not what you expect
• Your practice lacks an objective way to
evaluate provider performance
Our Approach:
• Develop a comprehensive understanding of the
practice’s culture, environment, personnel and
needs
• Identify appropriate technology solutions to
meet the practice’s unique qualities and
requirements
• Maintain and communicate awareness of “hot
topics” that practices need to be aware of
• Facilitate positive and productive
communication between the practice and
outside vendors
• Support the technology and take great care of
the practice to ensure that the practice runs
well and efficiently
Healthcare and Technology

18. How is your practice or client
currently performing?
• Depending on the current Electronic Medical Record
(EMR) it could be really hard to gauge.
• Do you have a formal way of tracking your quality
performance?
• Do you track any important financial metrics? If so,
how?
• What tools are you giving your providers for success?
• How do you hold providers accountable or incentivize
performance?
• How can Citrin Cooperman help?
Wrap Up

20. THANK YOU!
KIERAN HIGGINS
Supervisor
Citrin Cooperman
khiggins@citrincooperman.com
215.545.4800 x4146
HELPING YOU
FOCUS ON WHAT
COUNTS
Kieran has significant experience in financial projections, pro formas, budgeting, strategic operations
and revenue cycle quality assurance. With a formal education in political science and economics
Kieran has worked throughout his career to drive performance improvement using his understanding
of public policy and applying it to strategic health care financial operations.
Prior to joining Citrin Cooperman Kieran worked for a regional hospital system as a Senior Financial
Operations Manager for the employed physician group and ambulatory operations team. He directed
all of the value based performance collaborations and managed care negotiations. Kieran was the
project manager lead for the 300+ provider group monitoring all financial performance, operational
improvement, quality metrics, bonus structure and strategic alignment decision making. During
Kieran’s tenure he worked through the onboarding of over 15 new physician groups and helped
double the amount of primary and specialty care providers. He also co-directed RCM with the director
of finance to oversee all charge capture, billing and collections. During his tenure Kieran oversaw the
highest average daily cash collection rate in company history in addition to the least amount of
insurance denials through operational improvements.
WWW.CITRINCOOPERMAN.COM
LORRAINE S. VALLE, LMSW, CPPM
Manager
Citrin Cooperman
lvalle@citrincooperman.com
914.693.7000 ext. 122
Lorraine is a Manager in Citrin Cooperman’s Technology and Risk Advisory Consulting Practice
(TRAC), with a focus on healthcare. A Certified Physician Practice Manager (CPPM®), Lorraine
works closely with medical practices providing consulting services across a wide array of topics. As
an outsourced practice administrator, she has managed all aspects of practices including EHR
selection and implementation, MIPS measure management and attestation, vendor coordination,
oversight of the billing department, staff management and bookkeeping. Lorraine is a licensed
social worker and applies her training in all work with clients.