1. Quality Payment Program: MACRA and MIPS Basics for Small Practices
Lisa Gall, DNP, FNP, LHIT-HP
Chris Becker
November 21, 2017

2. Disclaimer
Content provided in this presentation is based on the latest information made available by the Centers for Medicare & Medicaid Services (CMS) and is subject to change. CMS policies change, so we encourage you to review specific statutes and regulations that may apply to you for interpretation and updates.

3. Quality Payment Program – First 2 Years
2017 Transition Year
2018 Year 2
Low Volume Threshold
Part B Allowed Charges
≤ $30,000
≤ $90,000
Part B Beneficiaries
≤ 100
≤ 200
Category Weights
Quality (Data Completeness)
60% (50%)
50% (60%)
Advancing Care Information
25%
Improvement Activities
15%
15% (20 new activities)
Cost 0%
10%
Reporting Period
Test Pace
Minimal Data
No option
90 Days Minimum
Partial Year – Quality, ACI, AI
ACI, IA
Full Year
CMS Web, CAHPS
Quality, Cost
Composite Scores
Minimum Avoid Negative Adjustment
3 points
15 points
Exceptional Care Bonus
points
points

4. Quality Payment Program – First 2 Years
2017 Transition Year
2018 Year 2
Quality Measure Score
3 point floor for measures without benchmarks or not meeting data completeness
1 point floor – large practices
3 point floor – small practices
Certified Electronic Health Record Technology (CEHRT)
2014 CEHRT required
2015 CEHRT optional
2015 CEHRT optional (bonus points for exclusive use)
Virtual Groups
None
Groups of 10 or fewer eligible clinicians can report together “virtually”
ACI Hardship Exemption
NP, PA, CNS, CRNA, non-patient facing, Hospital-based clinicians
Same as year 1 plus:
Small practices, clinicians in ASC, off campus OP Hospitals, EHR decertified, Natural disasters (hurricanes, fire)
E-Prescribing and Health Information Exchange Measures
Exclusions
Final Score Bonus Points for Small Practices (≤15 Clinicians)
5 bonus points as long as data submitted in at least one category
Final Score Bonus Points for Complex Patients
Up to 5 bonus points based on complexity of patient population
Bonus Points for Improvement
Up to 1 point in cost category
Up to 10 points in quality category .

5. Ongoing Questions?
Stratis Health (Minnesota) MetaStar (Wisconsin)