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MACRA: MIPS & APMs

MACRA is a law passed in April 2015 to replace the previous SGR program which governed how CMS pays physicians for their services.  StreamlineMD is keeping close watch on the development of this law's payment programs and will keep the links below updated with the latest information.

CMS Guide - https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html

QUALITY PAYMENT PLAN SUMMARY

Quality Payment Plan

The final rule with comment period for Quality Payment Program (MACRA) was released on Friday, October 14, 2016. Now what do I do?

Who can participate in the Quality Payment Program?

You’re a part of the Quality Payment Program if you bill Medicare more than $30,000 a year and provide care for more than 100 Medicare patients a year, and are a:

  • Physician
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist

 

Now that I qualify, what do I need to do to prepare for the new Quality Payment Program (MACRA)?

 

1.     Pick Your Pace: MIPS or APMs?

o   The majority of providers will fall into the MIPS category

2.     Once you select if MIPS or APM route is best for your practice, begin to educate yourself on the requirements

 

Merit-based Incentive Payment System (MIPS)

 

Don't Participate

Submit Something (Test)

Submit Partial Year (90 days)

Submit Full Year

Payment/Adjustment Amount

If you do not submit any data in 2017, you will receive a negative 4% payment adjustment in 2019

If you submit a minimum amount of data in 2017, you can avoid a downward payment adjustment in 2019

If you submit 90 days of data in 2017, you can earn a neutral or small positive payment adjustment in 2019

If you submit a full year of 2017 data, you may earn a positive 4% payment adjustment in 2019

 

Negative 4% adjustment

Avoid adjustment

Neutral or small payment

Positive Payment +4%

 

MIPS Consists of Four Categories:

1.     Quality (Replaces PQRS)

2.     Advancing Care Information (Replaces Meaningful Use)

3.     Improvement Activities (NEW CATEGORY)

4.     Cost (Replaces the Value-Based Modifier)*

*This category will be collected in 2017 but will not be used to determine your payment adjustment. In 2018, CMS will start to use this category to determine your payment adjustment.

 

MIPS Breakdown 2017

Category

Quality (PQRS)

Advancing Care Information

(Meaningful Use)

Improvement Activities (New Category)

Cost (Value Based Modifier)

2017 Category Weight

60%

25%

15%

Counted starting in 2018

Summary of Requirements

Select 6 measures with one being an outcomes measure for a minimum of 90 days.

5 required measures to earn 50%:

1.Security Risk Analysis

2.e-Prescribing

3.Provide Patient Access

4.Send Summary of Care

5.Request/Accept Summary of Care

 

By reporting on optional measures, providers can earn a higher score. Bonus score is available as well in 2017.

 

Reporting is for a minimum of 90 days.

Complete at least 4 activities or if small practice (fewer than 15 providers) 2 activities for 90 days

Not Required in 2017

Helpful Link for More Details of the Rule

https://qpp.cms.gov/measures/quality

https://qpp.cms.gov/measures/aci

 

For 2017, you will want to use the 2017 Advancing Care Information Transition Objectives and Measures

https://qpp.cms.gov/measures/ia

 

 

MIPS Payment Adjustment Amount

Year

2017

2018

2019

2020

2021

2022

Payment/Adjustment Amount

 

 

+/- 4%

+/- 5%

+/- 7%

+/- 9%

 

Advanced Alternative Payment Models (APM)

If you receive 25% of Medicare payments or see 20% of your Medicare patients through an Advanced APM in 2017, then you earn a 5% incentive payment in 2019.

You can choose to participate in one of these models (click on item for more detail):

  1. Comprehensive ESRD Care (CEC) - Two-Sided Risk 
  2. Comprehensive Primary Care Plus (CPC+) 
  3. Next Generation ACO Model 
  4. Shared Savings Program - Track 2 
  5. Shared Savings Program - Track 3 

You will need to apply for Advanced APMs by signing up here:  specific Advanced APMs 

 

 

References:

Quality Payment Program: https://qpp.cms.gov/

QPP Executive Summary: https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf

QPP Final Rule: https://qpp.cms.gov/docs/CMS-5517-FC.pdf

Visit this site for upcoming webinars: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-Events.html

AMA Website: http://www.rcmanswers.net/ama-introduces-new-tools-help-physicians-prepare-2017-macra/

Healthcare Informatics Info: http://www.healthcare-informatics.com/article/payment/healthcare-association-groups-stakeholders-respond-macra-finalized-rule-cautious?utm_campaign=Enews-2015&utm_source=hs_email&utm_medium=email&utm_content=36221127&_hsenc=p2ANqtz-9X-lCS931SEHkiVFwJUvVMDb9WGG38M22_kTKol4ru60iZ_RMBJR1OVAKK5u65YoMnrpG3PC8MjR87SQ2t7ohpNElBkA&_hsmi=36221127