MACRA UPDATE Presented by Judella Haddad-Lacle MD Associate Professor University of Florida

DISCLOSURE NOTHING TO DISCLOSE

OBJECTIVE Understand the 2 pathways for Medicare Payment reform. How to prepare for MACRA Be ready for the payment adjustment Timelines

MACRA Medicare Access and CHIP Reauthorization Act Is the new Medicare Quality Payment Program for Medicare participating physicians. MACRA program streamlines into 2 pathways: MIPS and APMs If you don’t choose one or take no action you will be included in the MIPS cohort.

MIPS Merit-Based Incentive Payment System PQRS Value-Based MU Payment Modifier

MIPS COMPONENT 2017 1-Quality : 60 % .Was Physician Quality Report System (PQRS) 2- Advancing Care Information(ACI): 25 %. Was Meaningful Use (MU). 3- Clinical Practice Improvement Activity (CPIA):15% 4- Cost : 0 % for 2017 was value-based modifier.

MIPS QUALITY REPORTING 60 % WEIGHTED Report 6 measures, 1 outcome measure for 90 days. Select quality measures from list qpp.cms.gov Each measure submitted have a baseline of 3 points. Bonus points by reporting 9 measures in 90 days

MIPS ADVANCING CARE INFORMATION 25% WEIGHTED 5 requirements: 1- Security risk analysis. 2- e-Prescribing. 3- Patient access. 4- Summary of care. 5- Request/accept summary of care.

MIPS Clinical Practice Improvement Activity 15 % WEIGHTED Complete up to 4 improvement activity for 90 days. Solo or small group attest that you completed 2 activities for 90 days. PCMH or APM designated as medical home automatically receive full credit for this category.

MIPS COST OR RESOURCE USE 0% for 2017

MIPS ELIGIBILITY Physicians(MD,DO,DMD and DDS) Physicians Assistants and Nurse Practitioners. Clinical nurse specialists. Certified registered nurse anesthetist.

MIPS EXEMPTIONS 2017 is the first year provider is participating in Medicare part B. Charges for Medicare part B fee-for-service patients are < $30.000 a year or volume < 100 patients in a year. Participating in the Advanced APM.

MIPS REPORTING Individual : Single National Provider Identification number (NPI) tied to a single Tax Identification Number (TIN).Payment is based on the individual performance. Group: Physicians with their own NPI sharing a TIN. Need to register as a group by June 30,2017.Payment based on the group performance. Reporting through Physicians Compare Website.

MIPS PUBLIC REPORTING Clinicians data will be posted on a public Web site in an easy to understand format. Medicare will provide feedback on the individual or group performance score and payment rate for 2019.

MIPS PERFORMANCE REPORTING OPTIONS MIPS test: Report minimum amount. 1 quality measure, 1 CPIA, or 4/5 ACI. No (-) adjustment Partial reporting participation: Submit partial data for 90 consecutive days: 1 quality measure,1 CPIA, 4/5 ACI. Potential for neutral or positive(<4%) payment adjustment.

MIPS PERFORMANCE REPORTING Full MIPS participation: Submit all requirements in all 4 categories for at least 90 consecutive days. Avoid (-) adjustment, opportunity for positive adjustment (4%), exceptional performers are eligible for bonus.

How MIPS affects Medicare payments

ALTERNATIVE PAYMENT MODEL APM Incentivized quality and value. Includes : -Centers for Medicare and Medicaid Innovation Center model (CMS) - Medicare Shared Savings Programs (MSSP).

ADAVANCED ALTERNATIVE PAYMENT MODEL Be a participant in selected APM model: -Comprehensive Primary Care Plus(CPC+). - Next generation ACO - Shared Savings Program Track 2 and 3. Certified EHR. Quality measures comparable to MIPS CPIA

APM REQUIRMENTS Recognized Medical Home model determined by the Center for Medicare and Medicaid Innovation. 25% of Medicare part B payments are through Advanced APM. 20% of Medicare part B patients volume are assigned to Advanced APM

APM DATA SUBMISSION Required to use certified EHR. Submission deadline is March 31, 2018 Earn 5 % incentive payment in 2019- 2024

MACRA PAYMENTS MIPS: 2019 +/- 4% 2020 +/- 5% 2021 +/- 7% 2022 +/- 9% APM: 2019-2024 + 5% bonus

Tools Available Now HEDIS Health Maintenance and Care Gaps PQRS MU

IMPORTANT DATES Performance period : January 1 - October 2, 2017 . Submit 2017 data for MIPS and APM to CMS: March 31 , 2018. If not submitted receive -4%. Report as a group : June 30, 2017

RESOURCES CMS.GOV aafp.org/practice management aafp.org/cfr/inthetrenches. MACRAnyms. EMRSystems.net

SUMMARY Macra : has 2 pathways MIPS or APM MIPS : has 4 categories (quality,ACI,CPIA and cost) APM: Must be a recognized medical home model, around 25% of Medicare part B payments and volume through advanced APM. If providers don’t select a pathway they will be assigned to MIPS.

SUMMARY Performance period : January 17-October 17 Submit data by March 31, 2017. Payments due in 2019. MIPS: payments can be neutral, positive or negative depending on benchmark scores. APM : +5% incentive payment. Pick your participation preference in MIPS: test, partial participation or full participation.

ACRONYMS MACRA: Medicare Access and CHIP Reauthorization Act. Chip: Children Health Insurance Program. MIPS: Merit-Based Incentive Payment System. ACI: Advancing Care Information. CPIA: Clinical Practice Improvement Activities. MU: Meaningful Use. PQRS: Physician Quality Reporting System. APM: Alternative Payment Model.

QUESTIONS? THANK YOU… GO GATORS…