2. Merit-Based Incentives Advocacy Leadership to Shape Change

3. Engage proactively Shape change Slow the pace of change Avoid surprises

4. Politics – Presidential – Congressional Policy – Executive (President, CMS, CMMI) – Congress (MedPAC) – Courts (AseraCare) Influencers Compassus – Education & Engagement Overview

5. President Proactive regulatory push for change; legacy Presidential Race Democracy in full view Senate Continued Republican/Democrat split; neither has 60 House Republican majority; conservative/moderate split Hospice Death squad rhetoric is dead (not fully buried); hospice and advance care planning value recognized; bipartisan support Politics: Elections & 2017

6. Hospice New payment, 5-star quality measures, program integrity outreach Physician Payment MIPS, ACP code Primary Care ACOs, CPC+ Quality, Data, Value Coordinated, Transitions, Person-Centered Policy: Executive (President, CMS, CMMI)

7. Medicare Advantage Carve in, 5-star EoL Domain Hospice Value, PI overreach Obamacare Repeal Medicare & Medicaid Entitlement Reform (pay for) PCHETA Momentum Policy: Congress (MedPAC)

8. Influencers Investor owned companies, and…

9. Influencers Jim Deal Corina Tracy Lucius Lampton Larry Doroshow Christian Sinclair William Frist

10. Advocacy Communications Monthly update, targeted op-eds Advocacy Grass Tops Key member of Congress and Compassus leaders Grassroots Broad-based email/letter support Strategic and coordinated involvement National associations and influencers Research Identify and use Compassus data to support public policy involvement Compassus: Education & Engagement

11. Political Action Committee 20152016 Established in July 2015 Raised $28,875 from Executive Leadership & Board Contributed $10,000 to 4 Senators, 3 Representatives Contributed $8,000 to 2 Senators, 2 Representatives (not PAC) Raised $10,000 this year to date Contributed $15,000 to 6 Senators, 4 Representatives Identified issue priorities: Educate on value MA 5 star for EoL domain Shape hospice payment reform

12. Advocacy & leadership engagement in your market – Access: Help shape emerging issues in advance care planning to improve access to hospice with development and implementations of MIPS Understanding CMS plans for MIPS development and implementation can improve access to hospice Public policy advocacy & leadership in Washington, D.C. – Medicare Advantage: 5-star EoL metrics before hospice carve in – Payment Reform: Shape change – VBP/Quality Measures: Define quality, shape direction – Access: Help shape emerging issues in advance care planning to improve hospice (MA, ACO, PAC, MIPS) – Broader and deeper MD/ED involvement with Congress – Proactive engagement with influencers 2016 Compassus Priorities

13. New Physician Payment Transition: Rapid Change from Volume to Value 2016 30% 85% 2018 50% 90% 2014 22% 85% 2011 0% 68% Alternative payment models e.g.; ACO FFS linked to quality e.g.; MIPS All Medicare FFS Historical Performance Goals

14. CMS: New Physician Payment Transition Physician Quality Reporting Program (PQRS) Value-Based Payment Modifier Medicare Electronic Health Records (EHR) Incentive Program Merit-Based Incentive Payment System (MIPS)

15. Are there any exceptions to participation in MIPS? There are 3 groups of clinicians who will NOT be subject to MIPS: 1 First year of Medicare Part B participation Note: MIPS does not apply to hospitals or facilities Certain participants in eligible alternative payment models Below low patient volume threshold

16. MIPS Changes How Medicare Pays Clinicians Services provided Adjustments *Or special lump sum bonuses through participation in eligible Alternative Payment Models Merit-Based Incentive Payment System (MIPS) Medicare Fee Schedule Final Payment to Clinician

17. How much can MIPS adjust physician payments? +/- Maximum Adjustments +4%+5%+4%+5% -4% - 5% -7%-7% -9%-9% +9%+9% +7%+7% Based on the MIPS composite performance score, clinicians will receive +/- or neutral adjustments up to the percentages below. Merit-Based Incentive Payment System (MIPS) 2019 2020 2021 2022 onward Adjusted Medicare Part B Payment to Clinician The potential maximum adjustment % will increase each year from 2019 to 2022

18. What will determine my MIPS score? The MIPS composite performance score will factor in performance in 4 weighted categories: Quality Resource use   Clinical practice improvement activities  Use of certified EHR technology MIPS Composite Performance Score

19. What will determine my MIPS score? The MIPS composite performance score will factor in performance in 4 weighted categories: Quality Resource use   Clinical practice improvement activities  Use of certified EHR technology MIPS Composite Performance Score *Quality measures will be published in an annual list *Clinicians will be able to choose the measures on which they’ll be evaluated

20. What will determine my MIPS score? The MIPS composite performance score will factor in performance in 4 weighted categories: Quality Resource use   Clinical practice improvement activities  Use of certified EHR technology MIPS Composite Performance Score *Will compare resources used to treat similar care episodes and clinical condition groups across practices *Can be risk-adjusted to reflect external factors

21. What will determine my MIPS score? The MIPS composite performance score will factor in performance in 4 weighted categories: Quality Resource use   Clinical practice improvement activities  Use of certified EHR technology MIPS Composite Performance Score *Examples include care coordination, shared decision- making, safety checklists, expanding practice access

22. What will determine my MIPS score? The MIPS composite performance score will factor in performance in 4 weighted categories: Quality Resource use   Clinical practice improvement activities  Use of certified EHR technology MIPS Composite Performance Score * % weight of this may decrease as more users adopt EHR

23. ACO: Accountable Care Organization CPC+: Comprehensive Primary Care Plus FFS: Fee For Service PAC: Post Acute Care PAC: Political Action Committee MA: Medicare Advantage MIPS: Merit-Based Improvement System Acronym Dictionary

24. Engage proactively Shape change Slow the pace of change Avoid surprises Craig.Jeffries@Compassus.com (828) 772-2843