1. GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability QPP Resources

2. Thank you to our Chapter Sponsors!
Elite Sponsors
Premier Sponsors
Partner Sponsors

4. Presenters Phoebe Nelms, CMUP Liz Hansen, CMUP, CHSP, CHSA, PCMH CCE
Lisbeth McPherson Hansen
Liz Hansen is an industry consultant, with over 25 years of experience in Information Technology within the ambulatory and acute Healthcare settings. A recognized expert in Meaningful Use assessment, project management and attainment, she serves as a Meaningful Use Specialist and Senior Advisor to the Georgia Health Information Technology Extension Center (GA-HITEC). Liz has assisted over 150 local practices in their successful efforts to achieve Meaningful Use Stage 1, in addition to providing guidance in EHR selection, portal development and Stage 2 readiness. She is also certified as a PCMH Content Expert and an ICD-10 Project Manager.
Liz serves on the Executive Board of the Georgia Chapter of the Health Information and Management Systems Society (GA-HIMSS), and is in her fifth year as a member of the GA-HIMSS Board of Directors. She has served as a member of the national HIMSS Meaningful Use Stage 3 Task Force, the HIMSS Chapter Leader Task Force, the Georgia HIE Task Force, the Georgia Health Information Network (GaHIN) and is a member of the Georgia ICD-10 Collaborative. Liz is a frequent speaker and subject matter expert at professional seminars on the topics of Meaningful Use, EHR Utilization, HIPAA Cyber Security Requirements and Social Media Management in the Healthcare Environment.
Phoebe Nelms is a Certified Meaningful Use Professional and serves as the Program Manager for Technical Outreach with GA-HITEC.  She is a member of The Healthcare Information and Management Systems Society (HIMSS). She works with GA-HITEC’s team to develop and create production of public information materials to further the national agenda for Health IT and delivers virtual and onsite education, outreach and technical assistance to providers in support of Meaningful Use attestations. 
Outreach activities also include the coordination of GA-HITEC’s webinars, and onsite (Morehouse School of Medicine) Privacy and Security Workshop focused on the HIPAA Security Risk Assessment. Phoebe is in process of becoming a Certified MACRA-MIPS Healthcare professional (CMHP) to assimilate and disseminate program requirements for Medicare Part B eligible clinicians.  
Phoebe Nelms, CMUP
Program Manager, Technical Outreach
GA-HITEC,
National Center for Primary Care
Morehouse School of Medicine
Liz Hansen, CMUP, CHSP, CHSA, PCMH CCE
HealthIT Consultant, GA-HITEC

5. Objectives Overview of MACRA’s Quality Payment Program
Review of Available Resources
Quality Payment Program Website
Small, Underserved & Rural Support Resources

6. What is MACRA?

7. Medicare Access and CHIP Reauthorization Act
What is MACRA?
Medicare Access and CHIP Reauthorization Act
Historic Medicare reform law
Bipartisan legislations signed April 16, 2015
Final Rule released October 14, 2016 by CMS
Creates a new framework for provider reimbursement
Consolidates existing quality reporting programs
Budget neutral
SRG (Sustainable Growth Rate) Each year, Congress passed temporary “doc fixes” to avert cuts (no fix in 2015 would have meant a 21% cut in Medicare payments to clinicians)
Fee-for-service (FFS) payment system, where clinicians are paid based on volume of services, not value.
MACRA replaces the SGR with a more predictable payment method that incentivizes value.
Consolidated PQRS, Meaningful Use and Value Based Modifier.

8. Why was new legislation needed?
Medicare is the main driver of future federal spending increases
Medicare is large enough to use as a vehicle to drive the US healthcare delivery system away from the fee-for- service model toward the quality and value-based reimbursement model

9. How is MACRA Implemented?
MACRA creates Medicare payment reform through the Quality Payment Program (QPP)
The Quality Payment Program is designed to make patients healthier by incentivizing clinicians to focus on quality. It’s not just about reporting. This new program gives clinicians new tools and resources to help them give patients the best possible outcomes.

10. How is MACRA Implemented?
MACRA is the legislation
QPP is the framework to achieve MACRA goals
MIPS and APMs provide for the measuring and reporting systems

11. The Quality Payment Program has two tracks
How is MACRA Implemented?
The Quality Payment Program has two tracks OR
Creates the Quality Payment Program (QPP)
QPP has two tracks –
Advanced Alternative Payment Models (APMs)
Merit-based Incentive Payment System (MIPS)
Combines parts of the following into MIPS;
Sustainable Grown Rate (SRG)
Physician Quality Reporting System (PQRS)
Value-based Payment Modifier (VBM)
Replaces Meaningful Use (Medicare only)

12. APMs – Alternative Payment Models
APMs Overview
APMs – Alternative Payment Models
An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. They may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.
 Advanced APMs must meet the following requirements:
 Be CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs
 Require participants to use certified EHR technology
 Base payments for services on quality measures comparable to those in MIPS
 Be a Medical Home Model expanded under Innovation Center authority or require participants to bear more than nominal financial risk for losses. The final rule with comment period defined the risk requirement for an Advanced APM to be in terms of either total Medicare expenditures or participating organizations’ Medicare revenue (which may vary significantly). This enhanced flexibility allows for the creation of more Advanced APMs tailored to physicians and other clinicians, such as advanced practice nurses, generally, and small practice participation in particular.
What happens if I am in an Advanced APM?
Once you're in an Advanced APM, you'll earn the 5% incentive payment in 2019 for Advanced APM participation in 2017 if:
You receive 25% of your Medicare Part B payments through an Advanced APM or
See 20% of your Medicare patients through an Advanced APM
If you leave the Advanced APM during 2017, you should make sure you've seen enough patients or received enough payments through an Advanced APM to qualify for the 5% bonus. If you haven't met these thresholds, you may need to submit MIPS data to avoid a downward payment adjustment.

13. Performance based payment adjustment categories
MIPS Overview
Performance based payment adjustment categories
60%
15%
25% 0%
How Does MIPS Work?
You earn a payment adjustment based on evidence-based and practice-specific quality data. You show you provided high quality, efficient care supported by technology by sending in information in the following categories: Quality, Improvement Activities, Advancing Care Information and in future years, Cost.
qpp.cms.gov

14. Positive payment adjustment Reputation – compared to other providers
QPP Reporting Impact
Incentives
Penalties
Positive payment adjustment
Reputation – compared to other providers
Early adopters get ahead on workflow and establish base line
Negative payment adjustment
Reputation – compared to other providers
More pressure as thresholds and negative payments increase
What is Physician Compare?
The Centers for Medicare & Medicaid Services (CMS) provides this site to givephysicians and other clinicians the latest resources and information about Physician Compare, a website designed to help consumers make informed choices about the health care they receive through Medicare.

15. MACRA TIMELINE with Payment Adjustments
Eligible Clinicians above the performance threshold will receive positive payment adjustments corresponding to the diagram starting in 2019.
Eligible Clinicians who fall within the lowest 25% of the performance threshold will experience payment reductions.
Exceptional performers receive additional positive adjustments from a $500M fund that will be available each year from 2019 to 2024.
2017: MIPS reporting begins
2019: MIPS payments begin

16. When Does it Start? Program begins January 1, 2017
Flexible start date for data collection
Final submission of performance data by March 31, 2018

17. Support Resources QPP Website QPP Helpline
Local Support for Large and Small Practices
Professional Societies
HIMSS
MGMA
ACO
Quality Improvement Organization (QIO/QIN/PTN)
Regional Extension Center
Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.)
Initiate Community of Care / Community of Practice meetings
Use professional society resources
Review and analyze MU and Quality reports
Patient Engagement Playbook
Participate in TCPI and/or PCMH
GA-HITEC assistance
Determine which track is best for your practice
Determine risk
GA-HITEC supporting Technical Assistance for ACI
Allocation of $20 million/year from to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM
Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting?
Do you meet requirements for small, rural, non-patient-facing accommodations?
Do you/ can you participate in a qualified clinical data registry?
Review your PQRS and QRUR reports and determine areas for improvement?

18. Premier Resource – QPP Website
Utilize the Quality Payment Program Website
General Information on the Quality Payment Program
Measure requirements and options
Resource library: Webinars, educational programs and support documentation
Let’s take a look at navigating this site
Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.)
Initiate Community of Care / Community of Practice meetings
Use professional society resources
Review and analyze MU and Quality reports
Patient Engagement Playbook
Participate in TCPI and/or PCMH
GA-HITEC assistance
Determine which track is best for your practice
Determine risk
GA-HITEC supporting Technical Assistance for ACI
Allocation of $20 million/year from to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM
Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting?
Do you meet requirements for small, rural, non-patient-facing accommodations?
Do you/ can you participate in a qualified clinical data registry?
Review your PQRS and QRUR reports and determine areas for improvement?

19. Support for Small Practices
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

20. Small, Underserved & Rural Support
Small practices with 15 or fewer clinicians, including those in rural locations, health professional shortage areas, and medically underserved areas are a crucial part of the health care system.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides direct technical assistance to help individual Merit-based Incentive Payment System (MIPS) eligible clinicians and small practices in these settings participate in the Quality Payment Program.
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

21. Small, Underserved & Rural Support
This initiative is comprised of local, experienced organizations that will help clinicians in small and rural practices:
Select and report on appropriate measures and activities to satisfy the requirements of each performance category* under MIPS
Engage in continuous quality improvement
Optimize their health information technology (HIT)
Evaluate their options for joining an Advanced Alternative Payment Model (APM)
Providing this support to clinicians will help them navigate the Quality Payment Program, while making sure they are able to focus on the needs of their patients.
*Quality, Cost, Improvement Activities, and Advancing Care Information
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

22. SURS Small, Underserved & Rural Support Georgia
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

23. Small, Underserved & Rural Support
Alliant Quality is the Quality Innovation Network-Quality Improvement Organization (QIN-QIO) for Georgia and North Carolina.
Alliant Health Solutions companies are making health care better in seven states. 
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

24. Small, Underserved & Rural Support
Funding for direct technical assistance to local, experienced organizations
Help for small and rural practices to engage in continuous quality improvement
Assistance to evaluate options for joining an Advanced Alternative Payment Model
Support to navigate the Quality Payment Program
GA-HITEC is funded to provide support in partnership with Alliant
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

25. Small, Underserved & Rural Support
Register for SURS
Complete short survey
Representatives will make contact
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

26. Additional Resources
TCPI – free support for Practice Transformation and MACRA
Patient Centered Medical Home (PCMH)
Assistance also available for practices >15 providers
Practices with 15 or fewer clinicians and practices in rural and health professional shortage areas are a crucial part of the health care system. The Quality Payment Program provides options designed to make it easier for you to report on your performance and qualify for incentives. Physicians in small practices who report their performance can do just as well as mid-sized or larger practices. We expect the number and percentage of small practices participating in the Quality Payment Program to increase and exceed participation in legacy programs (for example, PQRS) because of the reduced reporting burden, increasing usability of technology, and stepped-up technical assistance. There are a number of other flexibilities in the final rule with comment period to help small practices, including exemptions for low volume practices, allowances for patient-centered medical homes, and increased technical assistance. MACRA also provides $20 million each year for five years to fund training and education for Medicare clinicians in individual or small group practices of 15 clinicians or fewer and those working in underserved areas. Beginning December 2016, local, experienced organizations will use this funding to help small practices select appropriate quality measures and health IT to support their unique needs, train clinicians about the new improvement activities and assist practices in evaluating their options for joining an Advanced APM. Providing these tools to help physicians and other clinicians in small practices and practices in underserved areas navigate new programs is key to making sure they are able to focus on what is most important: the needs of their patients.

27. Path to Success
Participate in available webinars (HIMSS, REC, HIE, SURS)
Use professional society resources
Educate staff
Initiate Community of Care / Community of Practice meetings
Determine appropriate track (MIPS vs APM)
Determine method of reporting
Determine reporting period target
Determine risk
Review and analyze MU and Quality reports
Select Improvement Activity “best” suited for your practice
Determine where you are now, make a plan, work your plan
Participate in TCPI
Certify for PCMH
SURS and Large Practice assistance
Utilize your QPP Website
Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.)
Initiate Community of Care / Community of Practice meetings
Use professional society resources
Review and analyze MU and Quality reports
Patient Engagement Playbook
Participate in TCPI and/or PCMH
GA-HITEC assistance
Determine which track is best for your practice
Determine risk
GA-HITEC supporting Technical Assistance for ACI
Allocation of $20 million/year from to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM
Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting?
Do you meet requirements for small, rural, non-patient-facing accommodations?
Do you/ can you participate in a qualified clinical data registry?
Review your PQRS and QRUR reports and determine areas for improvement?

28. .

29. Latest Update

30. Questions / Discussion
Thank You!

31. References
State Public Health / CMS Quality Payment Program Google Images UAhWJwiYKHd8fCPMQ_AUICigB&biw=1017&bih=679 Physician Compare instruments/physician-compare-initiative/ MIPS Scoring Methodology Overview Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf

32. Thank you for your participation and input!
GA-HIMSS Community of Practice Meaningful Use, MACRA, HIE and Interoperability
Recording of session available
Next Meeting: August 16, 12:00
Let us know what you want to hear or if you would like to contribute
Additional CoPs available through GA-HIMSS
Thank you for your participation and input!

33. Path to Success
Participate in available webinars (HIMSS, REC, HIE, SURS)
Use professional society resources
Educate staff
Initiate Community of Care / Community of Practice meetings
Determine appropriate track (MIPS vs APM)
Determine method of reporting
Determine reporting period target
Determine risk
Review and analyze MU and Quality reports
Select Improvement Activity “best” suited for your practice
Determine where you are now, make a plan, work your plan
Participate in TCPI
Certify for PCMH
SURS and Large Practice assistance
Utilize your QPP Website
Participate in available webinars (National, local, HIMSS, RECs, HIEs, etc.)
Initiate Community of Care / Community of Practice meetings
Use professional society resources
Review and analyze MU and Quality reports
Patient Engagement Playbook
Participate in TCPI and/or PCMH
GA-HITEC assistance
Determine which track is best for your practice
Determine risk
GA-HITEC supporting Technical Assistance for ACI
Allocation of $20 million/year from to small practices to provide technical assistance regarding MIPS performance criteria or transitioning to an APM
Is your EHR certified? If so, is it the 2014 or 2015 edition? Does your vendor support Medicare quality reporting?
Do you meet requirements for small, rural, non-patient-facing accommodations?
Do you/ can you participate in a qualified clinical data registry?
Review your PQRS and QRUR reports and determine areas for improvement?