Purdue Research Foundation ©

2 MACRA and the Quality Reporting Program Tara Hatfield RN, BSN, CHTS-CP Purdue Healthcare Advisors

Purdue Research Foundation © 3 What is it? MACRA  Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  MACRA, bipartisan legislation, replaces the flawed Sustainable Growth Rate formula by paying clinicians for the value and quality of care they provide  The new “Quality Payment Program” has two paths:  The Merit-based Incentive Payment System (MIPS)  Advanced Alternative Payment Models

Purdue Research Foundation © 4 What is MIPS? Merit Based Incentive Program  Combines multiple Medicare Part B quality reporting programs into a single program  This new, single program is based on:  Quality (PQRS/VM-Quality Program)  Resource Use (Cost) (VM-Cost Program)  Advancing Care Information (Medicare MU)  Clinical Practice Improvement *MACRA does not alter or remove the Medicaid EHR Incentive Program

Purdue Research Foundation © 5 Who is eligible? Merit Based Incentive Program Year 1 & 2 Physicians Dentists Nurse Practitioners Physician Assistants Clinical Nurse Specialists Certified Nurse Anesthetists Year 3 and beyond providers may include: Occupational Therapists Physical Therapists Speech Therapists Audiologists Nurse Midwives Clinical Social Workers Dietitians

Purdue Research Foundation © 6 Who will NOT participate? Merit Based Incentive Program  Providers in their FIRST year of Medicare Part B participation  Providers with a low Medicare volume  Medicare claims </= $10,000  Provider care for </= 100 Medicare patients in one year  Providers participating in advanced alternative payment models

Purdue Research Foundation © 7 MIPS Performance Categories A MIPS Composite Score will be calculated based on the performance of 4 weighted categories  Quality - 50%  Resource Use - 10%  Clinical Practice Improvement Activities – 15%  Advancing Care Information – 25%

Purdue Research Foundation © 8 What is the requirement? Quality  Providers will choose 6 measures that are relevant to their practice  Must include one outcome measure or high value measure  Must include a cross-cutting measure OR  Providers can report a Specialty Measure Set

Purdue Research Foundation © 9 What is the requirement? Advancing Care Information  Providers will report key measures of patient engagement and information exchange  Providers are rewarded for their performance on measures that matter most to them  Two scores calculated  Base Score  Performance Score

Purdue Research Foundation © 10 Base Score Advancing Care Information  The Advancing Care Information base score is based on the reporting of 6 measures:  Protect Patient Health Information  Electronic Prescribing  Patient Electronic Access  Coordination of Care through Patient Engagement  Health Information Exchange  Public Health and Clinical Data

Purdue Research Foundation © 11 Performance Score Advancing Care Information  Physicians will select the measures that best fit their practice from the following measures:  Patient Electronic Access  Coordination of Care Through Patient Access  Health Information Exchange

Purdue Research Foundation © 12 What is the requirement? Clinical Practice Improvement Activities  Providers can choose from over 90 activities  Providers participating in a “Medical Home” automatically earn full credit  Providers participating in an advanced alternative payment model will automatically earn at least half credit

Purdue Research Foundation © 13 What is the Requirement? Resource Use  CMS will calculate these measures based on claims and availability of sufficient volume  There is no action for providers to take for this requirement

Purdue Research Foundation © 14 Base Payment Adjustments MIPS - Incentives and Penalties  Adjustments applied 2 years after performance year (e.g adjustment is based on 2017 performance year)  Performance threshold is mean or median of the composite score for all MIPS providers  Linear adjustment based on composite score, as compared to performance threshold  Scoring is either positive, negative, or zero/neutral  Highest performers eligible for “exceptional performance bonus”  Additional payment adjustment of +10% for MIPS providers exceeding the 25 th percentile of all MIPS scores above the performance threshold (through 2024)

Purdue Research Foundation © 15 Base Payment Adjustments MIPS – Incentives and Penalties MIPS – Incentives and Penalties Payment YearBase Adjustment 20194x% 20205x% 20217x% x% Performance Threshold Positive adjustments applied on a linear sliding scale: x is capped at 3.0 Negative adjustments applied on a linear sliding scale: Payment YearBase Adjustment % % % %

Purdue Research Foundation © 16 Non-MIPS Pathway ADVANCED APMs  Participants are required to meet the following criteria: 1.Use Certified EHR Technology (CEHRT) 2.Base payment on quality measures comparable to those in the MIPS quality performance category 3.Either:  Bear more than nominal financial risk for monetary losses OR  Is a Medical Home Model expanded under CMMI authority  Excluded from MIPS Participation  Does not change how APMs function or rewards value – It creates extra incentives for Advanced APM participation:  Potentially receive annual lump-sum 5% bonus on MPFS payments (2019 – 2024)

Purdue Research Foundation © 17 Questions?

Purdue Research Foundation © 18 CONTACT Tara Hatfield RN, BSN, CHTS-CP Managing Advisor Great Lakes Practice Transformation Network Clinical Lead (812) pha.purdue.edu