MACRA / MIPS

What’s the Quality Payment Program (QPP)?

CMS describes the Quality Payment Program as an initiative to improve Medicare by helping you focus on care quality and the one thing that matters most — making patients healthier. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate formula, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. If you participate in Medicare Part B, you are part of the dedicated team of clinicians who serve more than 55 million of the country’s most vulnerable Americans, and the Quality Payment Program’s purpose is to provide new tools and resources to help you give your patients the best possible care. You can choose how you want to participate based on your practice size, specialty, location or patient population.

 

MACRA/MIPS Timeline

Source: CMS, QPP, 2016

 

Performance:

The first performance period opens January 1, 2017 and closes December 31, 2017. During 2017, record quality data and how you used technology to support your practice. If an Advanced APM fits your practice, then you can join and provide care during the year through that model.

Send in performance data:

To potentially earn a positive payment adjustment under MIPS, send in data about the care you provided and how your practice used technology in 2017 to MIPS by the deadline, March 31, 2018. In order to earn the 5% incentive payment by significantly participating in an Advanced APM, just send quality data through your Advanced APM.

Feedback:

Medicare gives you feedback about your performance after you send your data.

Payment:

You may earn a positive MIPS payment adjustment for 2019 if you submit 2017 data by March 31, 2018. If you participate in an Advanced APM in 2017, then you may earn a 5% incentive payment in 2019.

 

The Quality Payment Program has two tracks.

1) Merit-based Incentive Payment System (MIPS)

If as a provider, you participate in traditional Medicare Part B, you have over $30,000 of Medicare claims and/or over 100 Medicare patients then you will participate in MIPS to avoid a reduction in payments from CMS. By participating in MIPS, you can earn a performance-based payment adjustment. MIPS will consolidate components of three existing programs, the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and the Meaningful Use EHR program into four new programs. PQRS will now be the Quality Measures; Meaningful Use is now Advancing Care Information and Clinical Practice Improvement is new. Claims will be used to measure costs, the fourth program. CMS finalized the first phase of this program on October 14, 2016. CMS, however, expects the program to evolve over multiple years and will therefore continue to receive comments as new initiatives are released.

CMS estimates that between approximately 592,000 and 642,000 eligible clinicians will be required to participate in MIPS in 2017. By 2019, 90 percent of eligible clinicians will participate, and MIPS-related adjustments that year will be evenly balanced between cuts totaling approximately $199 million and bonuses of about the same amount. Additionally, CMS will distribute the MACRA-allocated $500 million in additional incentive payments to high performing providers.

Happy Couple using HealthLoop

MIPS Performance Categories

  1. Quality Measures:
  2. Quality Measures will be selected annually through a call for quality measures process. A final list of measures will be published on November 1st of each year. The first list of quality measures was published in 4Q2016. MIPS-eligible clinicians or groups will report on at least six measures including at least one outcome measure.
    Browse the different MIPS measures and activities here.

  3. Improvement Activities:
  4. These measures are those that support broad CMS aims within the delivery of healthcare.

    1. Care Coordination
    2. Beneficiary Engagement
    3. Population Health
    4. Health Equity
  1. Advancing Care Information Performance:
  2. Measures and objectives in this category focus on secure exchange of health data, use of a certified EHR, support of patient engagement and quality improvement.

    1. ePrescribing
    2. Electronic Access to Data
    3. Health Information Exchange
    4. Coordination of Care/Patient Engagement
    5. Public Health Data Registry
  3. Costs:
  4. Cost measures do not require any reporting and will be pulled from CMS data. This will not be used to determine final score in the transition year, but information will be given back to clinicians.

    1. Total per capita costs
    2. 10 episode-based measures

Earn a payment adjustment based on evidence-based and practice-specific quality data. Show you provide high quality, efficient care supported by technology by sending in information in the following categories.

 

MIPS Measures

Source: CMS, QPP, 2016

 

 

Participation Levels

Pick Your Pace in MIPS – 2017

If you choose the MIPS path of the Quality Payment Program, you have four options.

Pick Your Pace in MIPS - 2017

Source: CMS, QPP, 2016

 

 

The Quality Payment Program has two tracks. (cont.)

2) Advanced Alternative Payment Models (APMs)

If you decide to participate in an Advanced APM through Medicare Part B, you can elect to become a qualified participant (QP) under the Advanced APM Model in Medicare’s Quality Payment Program. Participation allows you to earn additional incentives of up to a 5% lump sum (over and above incentives already in place under the current APM) for participating in an innovative payment model. Examples of Advanced APMs include CJR, the Cardiac Bundles and ACOs.

 

REQUIREMENTS INCLUDE:

  1. The APM must require participants to use Certified EHR Technology.
  2. The APM must provide payment for covered professional services based on quality measures comparable to those in the quality performance category under MIPS.
  3. The APM must either require that participating APM Entities bear risk for monetary losses of a more than nominal amount under the APM, or be a Medical Home Model expanded under CMS Innovation Center authority.

Happy Couple riding bikes

OTHER SPECIFICS:

  1. At least half of clinicians in the Advanced APM must use certified EHR technology.
  2. Payments will be tied to quality measures that are evidence-based,reliable and valid.
  3. At least one measure must be tied to outcomes.
  4. Performance periods for meeting APM criteria begins at the beginning of each calendar year starting in 2017.
  5. The payment year lags the performance period by two years.
  6. Advanced APMs must be re-qualified each year.

 

CURRENT ADVANCED APMs FOR 2017

Comprehensive Care for Joint Replacement (CJR) Payment Model (CEHRT)
Comprehensive End Stage Renal Disease Care Model (Two-Sided Risk Adjustments)
Shared Savings Program Track 2
Shared Savings Program Track 3
Next Generation ACO Model
Comprehensive Primary Care Plus (CPC+)
Oncology Care Model (Two-Sided Risk Adjustment)

FUTURE ADVANCED APM OPPORTUNITIES

Advancing Care Coordination through Episode Payment Model Track 1 (CEHRT)
ACO Track 1+
New Voluntary Bundled Payment Model
Vermont Medicare ACO initiative (as part of the Vermont All-Payer ACO Model)

 

DOWNLOAD CMS FACT SHEET on “Alternative Payment Models in the Quality Payment Program”

 

Helpful Links

For more information on the QPP, the MACRA final rule, or the effect of these new programs on patient engagement, please visit the resources below.

The Quality Payment Program (QPP)

Quality Payment Program https://qpp.cms.gov/

Quality Payment Program – Executive Summary https://qpp.cms.gov/docs/QPP_Executive_Summary_of_Final_Rule.pdf

MACRA

CMS has extended APMs to include the Medicare Shared Savings Program ACOs. This opens up APMs to include now more than 359,000 providers.
Shared Savings Program ACOs are groups of doctors and other health care providers who voluntarily work together with Medicare to provide high quality services to Medicare fee-for-service beneficiaries. By participating in an APM, the providers is exempt from MIPS.
CMS Announcement
https://www.cms.gov/Newsroom/MediaReleaseDatabase/Press-releases/2017-Press-releases-items/2017-01-18.html

MIPS Breakdown: 6 Must-know Parts of the MACRA Final Rule
http://www.beckershospitalreview.com/finance/mips-breakdown-7-must-know-parts-of-the-macra-final-rule.html

Breaking Down the MACRA Proposed Rule
http://healthaffairs.org/blog/2016/04/29/breaking-down-the-macra-proposed-rule/

Video Presentation for Quality Payment Program Call*
https://www.youtube.com/watch?v=nNm_3zlQAis&list=PLaV7m2-zFKpihHxb4AiWNjbsIUUKCGljK&index=1&t=118s

*Published on January 3, 2017.
The Quality Payment Program allows clinicians to choose the best way to deliver quality care and to participate based on their practice size, specialty, location, or patient population. During this CMS video, learn about the provisions in the recently released final rule.

MACRA Impact

What CMS Did on Patient Engagement in MACRA
http://medcitynews.com/2016/05/cms-patient-engagement-macra/

How Will MACRA Impact Patient Engagement, Care Coordination?
http://patientengagementhit.com/features/how-will-macra-impact-patient-engagement-care-coordination/

How Can Providers Drive Patient Empowerment in Healthcare?
http://patientengagementhit.com/news/how-can-providers-drive-patient-empowerment-in-healthcare