The ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
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1 The ABCs of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
2 Medicare Access and CHIP Reauthorization Act (MACRA) Repeals the Sustainable Growth Rate Moves to a payment system based on value instead of volume Consolidates CMS Quality Programs into the Merit-based Incentive Payment System (MIPS) Creates a pathway for Alternative Payment Models (APMs) 2
3 3
4 Two Pathways to Physician Payment through Medicare Merit-based Incentive Payment System Alternative Payment Models
5 MIPS PQRS, Value-based Payment Modifier and Meaningful Use will be consolidated into the Merit-based Incentive Payment System (MIPS) Fee-for-service payments will be adjusted for value over volume Effective 2019 (likely performance period 2017) 5
6 MIPS Four weighted components will determine payment bonuses and penalties A single composite performance score (0-100) will be used to determine physician payment Components Percent of Composite Quality 50% (decreasing to 30%) Resource Use 10% (increasing to 30%) Use of EHR Technology 25% Clinical Practice Improvement Activities 15% Total 100% 6
7 MIPS Exemptions Providers in their first year billing Medicare Providers whose volume of Medicare payments or patients fall below the threshold (not yet defined) Providers who qualify for payment under APMs with the associated bonuses are exempt from MIPS 7
8 What are APMs? An innovative payment model expanded under the Center for Medicare & Medicaid Innovation (CMMI); A Medicare Shared Savings Program (MSSP) accountable care organization (ACO); Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program; or Another demonstration program required by federal law. 8
9 How to Define a Good Payment Model Center for Healthcare Quality and Payment Reform
10 Qualified APMs Requirements Use of quality measures comparable to measures under MIPS; Use of a certified electronic health record (EHR) technology; and Assumes more than a nominal financial risk (which is undefined), ORis a medical home expanded under the CMMI. A physician receiving the designated percentage of Medicare payments or patients through a qualified, eligible APM based on the above requirements is considered a qualifying participant (QP). 10
11 APMS Unlike MIPS, APMs offer increased potential for risks and rewards Qualifying APM Participant: : Receive an annual 5% lump sum bonus payment 2026 beyond: Receive higher fee schedule update
12 Qualified APM Participant Requirements To avoid MIPS, must be a qualified APM participant APM must comprise a significant share of provider revenue or patients : 25% of Medicare payments furnished through APM : 50% of Medicare payments 2023 and beyond: 75% Beginning in 2021, anall-payer/medicare threshold combination will be available
13 How Do I Get Started Most physicians will begin on the MIPS track due to minimal risks involved Technical assistance will be provided through Quality Improvement Organizations (QIOs) and Regional Extension Centers (RECs) to practices with 15 or fewer eligible professionals participating in an APM or MIPS. This assistance is intended to position practices to transition to APMs or to improve MIPS composite scores. Priority will be given to practices in rural areas, health professional shortage areas, and medically-underserved areas.
14 TIPSto Prepare for MACRA Implementation Educate your physicians and mid-level professionals on the new payment models through MACRA. Review your quality metrics and identify your current performance. Become familiar with the data analytics of your practice. 14
15 TIPSto Prepare for MACRA Implementation If you are currently not participating in any of CMS quality programs, assess the penalty of nonparticipation in MACRA on your practice. Learn more about ASGE Quality initiatives and how they can help you with MACRA implementation. GIQuICBenchmarking Registry ( Endoscopy Unit Recognition Program ( Attend educational courses to help you develop a strategy to implement MACRA in your practices starting in
16 Upcoming ASGE Practice Operations Courses GI Outlook 2016: Redesigning and Rebuilding the GI Practice of the Future August 5-7, 2016, Washington, DC Practice Management 201: Looking at GI Practice Management Differently September 10, 2016, New Orleans, LA ASGE s Practice Management Trifecta: Building a Foundation of Excellence in GI Practice Management November 17-20, 2016, Downers Grove, IL 16
17 Resources ASGE MACRA Implementation Resource Center Centers for Medicare and Medicaid Services Initiatives-Patient-Assessment-Instruments/Value- Based-Programs/MACRA-QPP-MIPS-and- APMs/MACRA-MIPS-and-APMs.html 17
18 Questions Lakitia Mayo Director of Health Policy and Quality (630) Eden Essex Assistant Director of Quality and Policy (630)
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