1. NCHICA Health Policy Workshop  MACRA, Population Health & Impact to NC Providers
March 30, 2017
Roy Wyman, Esq. and Trish Markus, Esq. (Nelson Mullins)
Vivek Nanda, M.D. (Blue Cross and Blue Shield of NC)
Melanie Phelps, Esq. (NC Medical Society)

2. Rules of Order Presenters Audience Overview: Fireside chat
What is MACRA?
Why does MACRA matter?
What does MACRA do?
Fireside chat
Audience
Ask questions
Consider sharing your relevant experience

3. What Is MACRA? Medicare Access and CHIP Reauthorization Act of 2015
Enacted April 6, 2015
Effective January 1, 2017
Payment reform for Medicare Part B
MACRA aims to
Improve quality, patient health
Control spending
Advance use of EMRs
Incentivize change to clinical practices

4. Why Does MACRA Matter? Here’s what CMS has said:

5. What MACRA Does Repealed Sustainable Growth Rate formula
Phases out Medicare payment adjustments under current physician reporting programs
PQRS
Physician Value Based Modifier
EHR Incentive Programs (Meaningful Use)
Replaces these programs with MIPS track in Quality Payment Program (QPP)

6. What QPP Does
Ties payments to value (quality, cost, care coordination, care improvement, and outcomes) instead of volume
Contains two tracks:
Merit-based Incentive Payment System (MIPS)
Advanced Alternative Payment Models (APMs)

7. Implementation Timeline
Creates Payment Mechanisms through MIPS and APMs starting in 2019
First performance period begins in 2017, with adjustments to payments starting in 2019.
Providers are paid based on their participation in one of two tracks: Merit- based Incentive Payment System (MIPS) or as an Advanced Alternative Payment Model (APM)

8. What is MIPS?
Fee-for-service with performance-based adjustment on future Part B payments
Physicians will be given a composite reporting score focused on performance in 4 categories
Up to 4% bonus or penalty starting in 2019
Up to 9% bonus OR penalty starting in 2022
Performance measured against peers

9. What is MIPS? MIPS performance score based on:
Quality Reporting (60%) (similar to PQRS)
Chose six metrics to report by end of 2016 for performance year 2017
Advancing Care Information (25%) – Replaces Meaningful Use
Dropping CPOE and decision support requirements after 2017
Clinical Practice Improvement Activities (15%)
Flexible – can choose from 90 options – this is new
Examples include – care coordination; 24/7 access
Resource Utilization (0% in increases in coming years with decrease weight on quality)

10. To Whom Does MIPS Apply (or Not)?
MD, DO, DPM, DMD, OD, DC, PA, NP, CNS, CRNA
In 2021, will add physical, speech, and occupational therapists, audiologists, others paid under Physician Fee Schedules
Exempt:
First year Part B participants
Physicians with ≤ 100 Medicare patients or ≤ $30K in Medicare allowed charges
Non-patient facing physicians
Advanced APM participants
Physicians at RHCs, FQACs

11. Payment under MIPS in 2017

12. What are Advanced APMs?
Advanced APMs allow higher earnings to providers who take on risk related to patient outcomes
Advanced APMs more highly incentivized (automatic 5% bonus fee-for-service payments) than MIPS
≥ 50% of participants must use certified EHR technology
2017 Advanced APMs include Next Gen ACO, Comprehensive Primary Care Plus, Comprehensive ESRD Care, CJR Payment Model, Oncology Care Model, Shared Savings Program (Tracks 2 and 3)

13. Payment under Advanced APMs

14. MACRA Humor: One Physician’s Complaint about Reading MACRA

15. Fireside Chat and Your Take on MACRA

16. Resources https://qpp.cms.gov/
assn.org/sites/default/files/media- browser/public/physicians/macra/macra-faqs pdf
Initiatives-Patient-Assessment- Instruments/Value-Based-Programs/MACRA- MIPS-and-APMs/Small-Practices-Fact-Sheet.pdf
medicares-new-payment-system/

17. QUESTIONS????

18. NCHICA Health Policy Workshop  MACRA, Population Health & Impact to NC Providers
March 30, 2017
Roy Wyman, Esq. and Trish Markus, Esq. (Nelson Mullins)
Vivek Nanda, M.D. (Blue Cross and Blue Shield of NC)
Melanie Phelps, Esq. (NC Medical Society)