1. MACRA From the Trenches

2. 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Repealed SGR formula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

3. 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

4. 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

5. 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”

6. CMS Comes to Dallas

7. 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

8. 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

9. 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

10. 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

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

12. 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

13. 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

14. 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

15. 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

16. 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)

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