MACRA Measures & Insights
MACRA highlights New rule on Medicare physician reimbursement reforming the payment model via a quality-based payment program through bonus and penalties tied to performance. Broader push to overhaul federal health spending. 2017 is a transition year with changes expected every year. “Of 1,367 quality measures, more than 800 overlapped or had similar focus, according to the agency.” -NQF* *Source: http://www.healthcareitnews.com/news/new-nqf-guidance-aims-reduce-needless-quality-measure-variation Source: U.S. Officials Finalize Rule for Medicare Payment to Doctors Melanie Evans, Oct 14, 2016
MACRA creates two new payment tracks replacing the physician fee schedule: APM QP 0.5% 0.5% 0.5% 0% 0% 0% 0% 0% 0% 2026+ 0.75% PFS 2026+ 0.25% 2017 2018 2019 2020 2021 2022 2023 2024 2025 NON QP Payment year Performance year Value Based participation bonus 5% Alternative Payment Models (APMs) 2017 2018 2019 2020 2021 2022 2023 2024 2025 Payment year Performance year Up to +/- or neutral + Bonus up to 3x Merit-Based Incentive Payment System (MIPS) +/- 4% +/- 5% +/- 7% +/- 9% +/- 9% 2017 2018 2019 2020 2021 2022 2023 2024 2025
Regulatory and Payer Pressures At our last webinar we polled over 700 attendees about MACRA* and the number one concern from the audience was compiling metrics for regulatory reporting. A survey conducted in March, 2016 by Weill Cornell Medical College and the Medical Group Management Association (MGMA) found that physicians spend an average of hours every week processing quality metrics. 15.1 *Medicare Access and CHIP Reauthorization Act of 2015
Current State for Managing Measures
Align and Integrate the data Financial, regulatory AND quality departments need to come together. “We do quality initiatives focused on diabetes patients but I don’t know what other groups are doing.” “We have contracts with BCBS and Aetna that have quality measures in them as well, but we don’t know what they are.”
What is MACRA Measures & Insights? Foundation for integrating hundreds of measures across financial, regulatory & quality areas 212 of the 217 MACRA quality measures are pre-loaded out of the box. Platform supports most major EMRs, claims and other data sources. Enables proactive surveillance of measures to enhance outcomes Performance scores in three initial MIPS quadrants Helps organizations tactically & strategically identify measures for risk based contracts Add measures from commercial payer contracts Identify populations & measures for optimizing at-risk payments
Do You Have the Data to Support the Measure?
Monitor Your Performance to the Measures
MACRA Measures & Insights Foundation for integrating hundreds of measures across financial, regulatory & quality areas 212 of the 217 MACRA quality measures are pre-loaded out of the box. Platform supports most major EMRs, claims and other data sources. Enables proactive surveillance of measures to enhance outcomes Performance scores in three initial MIPS quadrants Helps organizations tactically & strategically identify measures for risk based contracts Add measures from commercial payer contracts Identify populations & measures for optimizing at-risk payments