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

2. DISCLOSURE
NOTHING TO DISCLOSE

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

4. 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.

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

6. 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.

7. 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

8. 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.

9. 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.

10. MIPS COST OR RESOURCE USE
0% for 2017

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

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

13. 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.

14. 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.

15. 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.

16. 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.

17. How MIPS affects Medicare payments

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

20. 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

21. 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

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

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

24. Tools Available Now
HEDIS
Health Maintenance and Care Gaps
PQRS MU

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

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

28. 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.

29. 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.

30. 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.

31. QUESTIONS?
THANK YOU…
GO GATORS…