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Greenway Health MACRA eBook

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Learn about how to prepare your practice for MACRA with this eBook created for Greeway Health.

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Greenway Health MACRA eBook

  1. 1. OTHERVISUALELEMENTS Preparing your practice for MACRA
  2. 2. 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
  3. 3. 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 Preparing your practice for MACRA 3
  4. 4. 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 Preparing your practice for MACRA 4
  5. 5. 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 Preparing your practice for MACRA 5
  6. 6. 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 Preparing your practice for MACRA 6
  7. 7. 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
  8. 8. 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 Preparing your practice for MACRA 8
  9. 9. 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 Preparing your practice for MACRA 9
  10. 10. 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 2018 performance period, you’ll get up to a positive or negative 5% adjustment depending on your performance in 2020 • For the 2019 performance period, you’ll get up to a positive or negative 7% adjustment depending on your performance in 2021 • 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 Preparing your practice for MACRA 10
  11. 11. 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 Preparing your practice for MACRA 11
  12. 12. 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 Preparing your practice for MACRA 12
  13. 13. 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 Preparing your practice for MACRA 13
  14. 14. 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 Improvement Activities Clinical Practice Improvement Activities 2017 CATEGORY WEIGHTS 2018 CATEGORY WEIGHTS 2019 CATEGORY WEIGHTS Preparing your practice for MACRA 14
  15. 15. 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 Improvement Activities 2019 CATEGORY WEIGHTS Preparing your practice for MACRA 15
  16. 16. 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 Improvement Activities 2019 CATEGORY WEIGHTS Preparing your practice for MACRA 16
  17. 17. 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 Improvement Activities 2019 CATEGORY WEIGHTS Preparing your practice for MACRA 17
  18. 18. 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 Improvement Activities 2019 CATEGORY WEIGHTS Preparing your practice for MACRA 18
  19. 19. ACI Measures – 2017 Preparing your practice for MACRA 19 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 Preparing your practice for MACRA 19
  20. 20. ACI Measures – 2018 onward Preparing your practice for MACRA 20 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 Preparing your practice for MACRA 20
  21. 21. Preparing your practice for MACRA 21 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 Preparing your practice for MACRA 21
  22. 22. MIPS Categories – Clinical Process Improvement Activities Preparing your practice for MACRA 22 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%) Preparing your practice for MACRA 22
  23. 23. Preparing your practice for MACRA 23 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 Preparing your practice for MACRA 23
  24. 24. Preparing your practice for MACRA 23 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. Preparing your practice for MACRA 24
  25. 25. OTHERVISUALELEMENTS Provider Strategies for MIPS
  26. 26. Preparing your practice for MACRA 25 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 Preparing your practice for MACRA 26
  27. 27. Preparing your practice for MACRA 26 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 Preparing your practice for MACRA 27
  28. 28. 2017 High Performance (scores exceeding 70) Preparing your practice for MACRA 27 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 Preparing your practice for MACRA 28
  29. 29. 2017 Test Your Systems (scores from 3–70) Preparing your practice for MACRA 28 It is strongly recommended that you upgrade to a 2015 Certified EHR Technology (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 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. Preparing your practice for MACRA 29
  30. 30. Preparing your practice for MACRA 29 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 Preparing your practice for MACRA 30
  31. 31. Preparing your practice for MACRA 30 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. Choose and start collecting data on: Six quality measures • 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. Preparing your practice for MACRA 31
  32. 32. Preparing your practice for MACRA 31 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. 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 youin what deciles • Consider trying to improve on a prior year’s CQM to take advantage of improvement scoring under MIPS Preparing your practice for MACRA 32
  33. 33. 2018 High Performance (cont’d) Preparing your practice for MACRA 32 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 Preparing your practice for MACRA 33
  34. 34. 2019? Preparing your practice for MACRA 33 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 Preparing your practice for MACRA 34
  35. 35. Greenway Health: A Record of Success in Value-based Care Preparing your practice for MACRA 34 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. Preparing your practice for MACRA 35
  36. 36. Simplifying MACRA Participation Minimize confusion and disruption as you tackle MACRA and MIPS challenges. [CTA HERE] Preparing your practice for MACRA 35 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. Preparing your practice for MACRA 36

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