2. Secrets to Beating the Curve
MIPS & MACRA
Secrets to Beating the Curve

3. Measured Against the Performance Standard for MIPS
Rules in Effect Now
Will Adjust Payment in 2019
It’s Almost 2018!
(Don’t Plan to Quit 12/31/2018)
Measured Against the Performance Standard for MIPS

4. How Do We Start TOGETHER Get psychologically prepared
Most don’t want, some don’t like, but that ABSOLUTELY does NOT MATTER
Get physically prepared
It’s going to take MORE TIME & Money
Let’s DO IT, Let’s Do It RIGHT, and Let’s Do It
TOGETHER

5. MACRA Medicare Access & Chip Reauthorization Act of 2015
Move from Volume-based fee-for-service pay to Value-based incentive pay
Quality Payment Program
(Designed to “FIX” cost control issues)
Revenue Neutral!

6. MIPS and Advanced APMs Merit-based Incentive Payment System
All Clinicians EXCEPT, 1st year, Below Threshold ($30K & 100 patients) & Certain Advanced APMs
[Hospitals, and Facilities]
{Rural Providers & Less than 15}
Participation Years 1 & 2 Physicians, PAs, NPs, Clinical nurse specialists, Certified registered nurse anesthetists
Everyone else get ready!

7. MIPS and Advanced APMs Most are MIPS!
Advanced Alternative Payment Models
Only QP and Advanced APM , partial for non-QP
Taking the place of Physician Quality Reporting System (PQRS), Value-based Payment Modifier, and EHR or Meaningful Use
Most are MIPS!
(About 100,000 out of 600,000 w/ 50K margin of Error)

8. (It’s the CMS.gov Website)
First Things First
Check National Provider Identifier (NPI)
(It’s the CMS.gov Website)
Check Reimbursement & Patient Population for Medicare Part B
Most Providers are MIPS, could be MIPS APM
Advanced APMs
Risk/Benefit Analysis

9. Critical Dates Full Participation 2017
Report for 90 days after January 1, 2017
Submit some data in 2017 (Neutral)
1 Quality or 1 Improvement or 4-5 Required Advancing Care
Start by October 2, 2017
Performance Data due March 31, 2018

10. MIPS Submission Methods
Administrative Claims
EHRs
Qualified Clinical Data Registries QCDR and Qualified Registries
CMS Web Interface (only Groups of 25+ & already Registered)
CAHPS for MIPS Survey (Consumer Assessment of Healthcare Providers and Systems (Groups & already Registered)
Attestation

11. How to REPORT www.VisualizeHealth.Co Visualize Health
CMS has a list of QCDR and Qualified Registries for MIPS Reporting (can submit all!)
100 entities on the list, ONE (1) QCDR is based here in Middle Tennessee
Visualize Health
It appears there is one registry out of Knoxville
(Some of them do not support ALL measures, so be Careful!)

12. Question About ACOs
Some Accountable Care Organizations (ACOs) indicate MIPS Reporting is not necessary …WRONG!
(There are Some ACOs Qualifying at Advanced APMS)
Get it in writing!
Without indemnity, may be no recourse

13. Initial Gain or Loss + or – 4% (with Fee Schedule up .5% thru 2019)
Incentive increasing to 9% by 2022
(additional Fee Schedule up.25%MIPS
and .75% for Advance APMS from 2026)
Opportunity for Advanced AMPs to earn an additional 5% (Not MIPS)
Must be a Risk Component to the Provider
Or Special Group
New Quality Measures- Yea!!

14. Composite Performance Score (CPS)
Each Improvement Category is assigned a weight or value as a percentage of 100%
Quality 60% (Replaces PQRS)
Advancing Care 25% (Replaces EHR & Meaningful Use)
Clinical Practice Improvement 15% (NEW)
Cost 0% (Replaces Value-based Modifier)
Cost is not utilized in 2017 reporting
This should change in the future

15. Quality = 60% Report up to 6 Quality Measures
168 High Priority Measures
(Reporting the minimum may have negative impact later)
Including 1 Outcome Measure
Readmissions or Potentially Avoidable Events
60 Points
90 days
QCDR, Qualified Registry, EHR, and Claims

16. Advancing Care Info = 25%
2 Tracks- Objectives & Measures or Transition
Fulfill Required Measures
Security Risk Analysis (HIPAA & HITECH)
ePrescribe
Patient Access
Summary of Care
Request/Accept Summary of Care
15/11 Measures depending upon Transition option
50 base +90 performance +15 bonus = 155 points possible, but capped at 100%

17. Advancing Care Info
Up to 9 Measures for Additional Credit (7 for Transition)
Eligible Improvement Activities
Certain Activities Apply for Base & Performance
100 Points
90 Days
FOR BONUS -Public Health, Clinical Data, CEHRT
QCDR, Qualified Registry, EHR, and Attest

18. Improvement Activities = 15%
Report 4 Improvement Categories
92 Improvement Categories
9 Subcategories
14 High Weighted
Only need 2, or 4 Medium Weighted
Double points for less than 15 or Rural
40 Points
90 days
QCDR, Qualified Registry, EHR, and Attest

19. Clinical Practice Improvement Activities
Actually 40 Now

20. Improvement Activities
Already added More Improvement Measures
Try for high weighted measures first
Do not do the MINIMUM
Do not do NOTHING
Remember, we are doing it TOGETHER, so just reach out, get some help, and get ‘er done!

21. CPS (Composite Point Score)
If Quality is 42 of 60 points or .7 (70%) x 60% = 42 points
If ACI is 50 of 100 points or .5 (50%) x 25% = 12.5 points
If IA is 30 of 40 points is .75 or (75%) x 15% = 11.3 points (rounded up from 11.25)
Cost = (14 of 20 points) x 0% weight x 100 = 0 points
Total MIPS points = = 65.8

22. Cost 0-30% Currently, Cost is set at Zero for 2017 and 2018
Approximately 40 cost measures
20 Points
Claims Based Reporting

23. Advanced APMs Certified Electronic Health Record Technology (CEHRT)
Quality Measures like MIPS
expanded Medical Home Model (100% of IA for MIPS) or bear more than nominal Risk for $ Losses
MIPS APM gets Special APM Scoring Too

24. ($20,000 to comply MIPS vs. $200,000 potential Loss)
Advanced APMs
Subset of APM, so most APMs will report MIPS
Advanced = RISK (Only 13 Made the List)
Few Models and Provider is required to Reimburse CMS for Missed Targets
Qualify for Extra 5% reimbursement
Depending on volume, may not be worth risk
($20,000 to comply MIPS vs. $200,000 potential Loss)

25. Secrets to Beating the Curve
MIPS & MACRA
Secrets to Beating the Curve

26. 1. Just Do It thanks NIKE
2. Get Help 3. Submit Something 4. Do Not Submit the Minimum 5. Look at the Measures and Go for the High Weighted ones 6. Reap the Rewards

27. Public Service Announcement (PSA)
Reminder:
60 Day Reimbursement Rule
Reporting and Returning SELF-Identified Overpayments
Medicare Parts A & B
Within 60 days of identification or at Cost Report
Medicare Parts C and D are covered under a different rule (sort of)
Through the exercise of Due Diligence
Meaning What?
Six (6) year lookback period

28. Julie-Karel(JK) Elkin, Member & CCO Data Privacy & Security Team
Spicer Rudstrom PLLC
(office)
(cell)