MACRA From the Trenches

Medicare Access and CHIP Reauthorization Act The Law Repealed SGR formula Two payment tracks – MIPS or Advanced APMs Consolidated PQRS, Meaningful Use, Value- Based Modifier Old: Penalties up to 11% New: Bonuses/Penalties up to 4-9% Additional bonuses possible Advanced APM – 5% bonus

Not What Congress Ordered CMS Draft Rule Costly reporting and compliance Disjointed timelines Metrics outside physician control Data two years too late Arbitrary incentives force practice consolidation No benefit to Medicare or patients

TMA member-physicians submitted 656 comment letters to CMS 50 Ways to Fix MACRA TMA Recommends Exempt more physicians More time for transition Simpler and better measures Quality metrics under physician control Make EHR vendors do the work TMA member-physicians submitted 656 comment letters to CMS

Opening Up the Channels AMA builds listening relationship with CMS CMS team met with 100,000+ in listening sessions Slavitt: “We listened and made changes based on your input”

CMS Comes to Dallas

The Final Rule Exempted: “Pick Your Pace” transition plan Fewer than 100 Medicare patients, or Less than $30,000 in Medicare charges “Pick Your Pace” transition plan Flexibility for quality measures and reporting mechanisms Report just 90 days of EHR use in 2017 Cost category will not count in 2017 Fewer practice improvement activities required

Pick Your Pace Approach Send No Data Automatic 4-percent penalty MIPS Option 1 Submit a minimum of 2017 data to Medicare (NO penalty) MIPS Option 2 Submit 90 days of 2017 data to Medicare (small bonus possible) MIPS Option 3 Submit a full year of 2017 data to Medicare (moderate bonus possible) OR ... Participate in an Advanced APM

Improvements We Won Of our 50 suggestions: Big wins: 21 completely accepted 13 partially accepted 16 rejected Big wins: 2017 a “transition year” in many different respects Many options for appropriate measures Hardship exclusions retained Reduced reporting burden overall

What Remains to Be Done? From Congress: From CMS: Establish adequate Medicare payment updates Eliminate penalties Set meaningful, objective performance standards Simplify reporting and compliance requirements Expand exclusions for small practices Work with IT vendors to establish low-cost systems Require appropriate risk adjustment Revise APM requirements From CMS: Long-term flexibility for small practices Accountability for IT vendors More pathways for existing APMs Real-time feedback on performance Better system to select measures Hold-harmless policy Do away with all-payer data submissions Refine and finalize virtual groups

Physicians In The Dark TMA Free Education Is-It-Worth-It Calculator Mind-Numbing MACRA: Strategies for Survival Texas Quality Summit MACRA Resource Center

Five Step Checklist Pick APM or MIPS Assess current performance on PQRS, meaningful use, VBM Review MIPS quality measures and reporting mechanisms Contact your EHR vendor Explore list of practice improvement activities

Don’t Call Us … We’ll Call You MACRA TeleTown Hall Meeting July 27, 2016 2,500 physicians participated Hour-long briefing on the law, the rule, preparing 69% knew nothing about MACRA

Lunch-Hour Webinars on Draft Rule Up to Speed Quickly Lunch-Hour Webinars on Draft Rule Participate or Penalty? You Decide Quality Reporting — Do It Right or Don’t Get Paid Neutralize Penalties With New Revenue Technology’s Secrets to Success

Details, Details TMA’s MACRA-Ready consulting services Readiness assessment Customized on-site help TMA PracticeEdge ACO services Medicare & MACRA: Get Clarity & Direction Statewide seminar series Understand the big changes coming

Miles to Go Before We Sleep Medscape September survey – “widespread ignorance” MACRA 28.6% haven’t heard of it 39.2% don’t know a lot about it MIPS 40.2% haven’t heard of it 34.9% don’t know a lot about it Brand new APM types coming (physician-focused payment models)

What Else Can, Should We Do For Our Members? MACRA From the Trenches