MACRA, MIPS, and APMs What to Expect from all these Acronyms?!
|
|
- Rosamund Floyd
- 6 years ago
- Views:
Transcription
1 MACRA, MIPS, and APMs What to Expect from all these Acronyms?! ACP Pennsylvania Council Meeting Saturday, December 5, 2015 Shari M. Erickson, MPH Vice President, Governmental Affairs & Medical Practice
2 What a long, strange trip it s been After 12 years of lobbying Congress to repeal the SGR, we finally wore them down! 2
3 So, what did we get instead? Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Congressional Intent of MACRA, beyond SGR repeal: Improve care for Medicare beneficiaries Change our physician payment system from one focused on volume to one focused on value 3
4 MACRA is part of a broader push towards value and quality In January 2015, the Department of Health and Human Services announced new goals for value-based payments and APMs in Medicare Source: 4
5 MACRA Overview/Acronym Definitions The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015 Merit-Based Incentive Payment System (MIPS) Alternative Payment Models (APMs) 5
6 Starting in 2019*, physicians will choose from or land in one of two paths: MIPS or APMs? Merit-based Incentive Payment System Alternative Payment Model * This decision will actually need to be made sooner than The initial performance period for MIPS in MACRA is 2017.
7 Two pathways: MIPS versus APMs (2019) MIPS MIPS adjusts traditional fee-forservice payments upward or downward based on new reporting program, integrating PQRS, Meaningful Use, and Value- Based Modifier Measurement categories (composite score of 0-100): Clinical quality (30%) Meaningful use (25%) Resource Use (30%) Practice improvement (15%) APMs Supported by their own payment rules, plus 5% annual bonus FFS payments for physicians who get substantial revenue from alternative payment models that Involve upside and downside financial risk, e.g. ACOs or bundled payments OR PCMHs, if quality with or cost; cost with or quality (e.g., CPCI) 7
8 Merit-Based Incentive Payment System (MIPS) 8
9 MIPS changes how Medicare links performance to payment There are currently multiple individual quality and value programs for Medicare physicians and practitioners: Physician Quality Reporting Program (PQRS) Value-Based Payment Modifier Medicare EHR Incentive Program MACRA streamlines those programs into MIPS: Merit-Based Incentive Payment System (MIPS) Source: 9
10 What MIPS means for Medicare s PQRS, Value-based Payment Modifier Program, and Meaningful Use PQRS, VBM, and MU no longer exist as standalone programs starting in In fact 2016 is the FINAL reporting period for all of these programs as stand alones! However, the infrastructure for these programs is expected to be used for MIPS beginning in This is an opportunity to improve them all! 10
11 How will physicians and practitioners be scored under MIPS? A single MIPS composite performance score will factor in performance in 4 weighted performance categories: Quality 30% Resource use 30% Clinical practice improvement activities Meaningful use of certified EHR technology 15% 25% MIPS Composite Performance Score Source: 1 1
12 * NEW* Clinical Practice Improvement Activities The subcategories shall include at least the following: Expanded practice access Population management Care coordination Beneficiary engagement Patient safety and practice assessment Participation in an APM Must be established in collaboration with professionals The Secretary must consider if they are attainable for small practices those in rural and underserved areas. Key Question: How will these need to be reported/tracked? Need to ensure minimal burden but still push toward value. 12
13 Clinical Practice Improvement Activities PCMH and PCMH Specialty Practices Certified PCMH and PCMH specialty practices receive highest potential score Key questions (to be answered via rulemaking): What will be the role of existing PCMH and PCMH specialty practice accreditation and recognition programs? Will CMS consider PCMH programs that are led by other payers, states, etc.? 13
14 How much can MIPS adjust payments? Based on the MIPS composite performance score, physicians and practitioners will receive positive, negative, or neutral adjustments up to the percentages below. MIPS adjustments are budget neutral. A scaling factor may be applied to upward adjustments to make total upward and downward adjustments equal. MAXIMUM Adjustments 4%5% 7%9% -4%-5% -7% -9% onward Adjustment to provider s base rate of Medicare Part B payment Merit-Based Incentive Payment System (MIPS) Source: 1 4
15 Are there any exceptions to MIPS adjustments? There are 3 groups of physicians and practitioners who will NOT be subject to MIPS: 1 FIRST year of Medicare participation Participants in eligible Alternative Payment Models who qualify for the bonus payment Below low volume threshold Note: MIPS does not apply to hospitals or facilities Source: 10
16 Alternative Payment Models (APMs) 16
17 Alternative Payment Models (APMs) APMs are new approaches to paying for medical care through Medicare that incentivize quality and value. According to MACRA law, APMs include: CMS Innovation Center model (under section 1115A, other than a Health Care Innovation Award) MSSP (Medicare Shared Savings Program) Demonstration under the Health Care Quality Demonstration Program Demonstration required by Federal Law MACRA does not change how any particular APM rewards value. APM participants who are not Qualified Participants will receive favorable scoring under MIPS. Only some of these APMs will be eligible APMs. Over time, more APM options will become available Source: 1 7
18 Two basic screens for APMs Eligible APM: The most advanced APMs that meet the following criteria according to the MACRA law: Base payment on quality measures comparable to those in MIPS Require use of certified EHR technology Either (1) bear more than nominal financial risk for monetary losses OR (2) be a medical home model expanded under CMMI authority Qualifying APM participants (i.e., qualifying participants or QPs): Physicians and other clinicians who have a certain % of their patients or payments through an eligible APM 18
19 How does MACRA provide additional rewards for participation in APMs? Most physicians and practitioners who participate in APMs will be subject to MIPS and will receive favorable scoring under the MIPS clinical practice improvement activities performance category. APM participants Those who participate in the most advanced APMs may be determined to be qualifying APM participants ( QPs ). As a result, QPs: 1. Are not subject to MIPS 2. Receive 5% lump sum bonus payments for years Receive a higher fee schedule update for 2026 and onward QPs Source: 1 9
20 Independent PFPM Technical Advisory Committee PFPM = Physician-Focused Payment Model Encourage new APM options for Medicare physicians and practitioners. Submission of model proposals Technical Advisory Committee (11 appointed care delivery experts) Review proposals, submit recommendations to HHS Secretary Secretary comments on CMS website, CMS considers testing proposed model Source: 19
21 Source:
22 PCMH as an Alternative Payment Model in MACRA Strict definition initially: PCMH as expanded under the CMS Innovation Center can be an eligible APM without taking on financial risk i.e., the Comprehensive Primary Care (CPC) Initiative But There are lots of other PCMH programs across the country Initially, they will fall under MIPS (but will score well there!) However, over time this is expected to change 22
23 PCMH as an APM in the future Beginning in 2021, the threshold % (of payments or patients) to be an eligible APM (and a QP) may be reached through a combination of Medicare and other non-medicare payer arrangements, such as private payers and Medicaid. The physician-focused payment model pathway is intended to allow for more APMs to be counted. Bottom line If you are in primary care, becoming a PCMH is the answer! For subspecialists, becoming a PCMH neighbor/specialty practice will be a huge benefit! 23
24 *Exceptional performance adjustment for those with the highest composite scores, limited to additional adjustment of 10% per year. **HHS can increase the maximum MIPS positive adjustment (not counting the exceptional performance adjustment) to no more than 3x maximum MIPS incentive adjustment for that calendar year, if there are sufficient funds available. HHS cannot increase the maximum negative MIPS adjustment by more than the amount specified. Prepared by the American College of Physicians, Division of Governmental Affairs and Public Policy Under MACRA, what s the range of possible FFS updates and incentive payments per year? (Physicians can participate in either MIPS or APM, not both) Date Baseline MIPS (incentive adjustments), without exceptional performance adjustment* Baseline, plus/minus MIPS, without exceptional performance adjustment* MIPS maximum, with exceptional performance adjustment* APM (FFS bonus only, does not include incentives from own APM pay structure) % instead of 21% SGR cut N/A N/A N/A N/A thru % N/A N/A N/A N/A % +/ % +/ % +/ - 4.0%** = -3.5% to +4.5%** 14.5% FFS bonus: +5% 5.0%** = -5.0% to +5.0%** 15% FFS bonus: +5% 7.0%** = -7.0% to +7.0%** 17% FFS bonus: +5% 2022, 2023 and % +/ - 9.0%** = -9.0% to + 9.0%** 19% FFS bonus +5% % +/ - 9.0%** = -9.0-% to plus 9.0%** N/A 0% 2026 and subsequent years 0.25% (for non-apm physicians only) +/ - 9.0%** = -8.75% to plus 9.25% ** N/A 0.75%
25 MACRA Implementation 25
26 MACRA Implementation Timeline October Medicare Physician Fee Schedule Final Rule Released Two Meaningful Use final rules released. New 60-day comment period on Stage 3 A Request for Information (RFI) released from CMS on both MIPS and APM pathway implementation Spring 2016 MU Stage 3 Final Rule MACRA Proposed Rule MACRA Measure Development Plan Summer Physician Fee Schedule Proposed Rule Fall Physician Fee Schedule Proposed Rule MACRA Final Rule (for the 2017 performance period; 2019 MIPS payment adjustment period) Annual list of MIPS quality measures (by Nov. 1 for 2017 performance period) 26
27 Relevant 2016 Physician Fee Schedule Changes PQRS Changes for 2016 Minimal! Are now allowing group reporting via QCDRs Did not finalize a proposal that group practices with 25+ EPs report on CAHPS for PQRS survey measures Only groups of 100+ EPs will need to report on CAHPS in 2016 Value-Based Payment Modifier Changes for 2016 also Minimal! Maintain the 2015 amount at risk of 4.0% for groups of 10 or more EPs Solo EPs and small group practices (2-9 EPs) are no longer held harmless (can face a -2% adjustment) 27
28 Changes to Quality Measures for PQRS 4 new cross-cutting measures (bringing total to 23) 37 new individual quality measures (8 proposed measures not finalized) 281 total measures in the PQRS measure set and 18 measures in the GPRO web interface for new measures groups: Cardiovascular Prevention Diabetic Retinopathy Multiple Chronic Conditions 28
29 Summary of CY 2018 Payment Adjustments Based on reporting in performance year 2016 PQRS: -2.0 percent for failing to satisfactorily report Meaningful Use of EHRs: -3.0 percent for failing to attest to MU Value-based Payment Modifier maximum downward adjustments: -4.0 percent for groups of 10 or more EPs -2.0 percent for solo and groups of 2 9 EPs 29
30 MACRA Request for Information Comments Submitted November 17 th * MIPS Topics (97 questions) include: MIPS Participation determination and options Measurement Categories Composite Performance Score and Threshold, including Flexibility in Weighting Public Reporting on Physician Compare Feedback Reports Technical Assistance for Small and Rural Practices APM Topics (50 questions) include: Eligible APM Entity Requirements Qualifying and Partial Qualifying APM Participants Payment Incentive for APM Participation Patient Attribution Nominal Financial Risk definition Medicaid: Medical Homes and Other State APMs Physician-Focused Payment Models * acp_comment_letter_macra_rfi_2015.pdf 30
31 Highlights of ACP Comments on MACRA RFI Called on CMS to use the opportunity provided through the new MACRA law to build a learning health and healthcare system. Recommended that CMS work to ensure that patients, families, and the relationship of patients and families with their physicians are at the forefront of the Agency s thinking. 31
32 ACP s RFI Comments: Key Principles for MACRA Implementation Support delivery system improvements. Avoid administrative and cost burdens for patients. Reduce administrative burdens for physicians. Improve current quality and reporting systems. Recognize patient diversity. Provide choice of payment models. Be equitable. Be relevant and actionable. Provide stability and resources. Be transparent. 32
33 Meaningful Use Rules Summary Proposed Stage 3 Certification Proposed Stage 3 MU Proposed Stage 2 MU modifications 1) Final 2015 Certification 2) Stage 3 MU & Final Stage 2 MU Modifications What is final Stage 2 modifications for Certification Requirements So, what about Stage 3 Now that MACRA has passed, CMS wants to take more time to finalize these rules. Therefore, Stage 3 MU will not be finalized until This is exactly what ACP had asked for a brief pause in rollout to make some changes!!! Stage 3 is optional for 2017, required in MU will be the first reporting period for MIPS. 33
34 Stage 2 Modifications finally final, but not ideal in terms of timing Key ACP asks 90-Day Reporting Period for 2015 What happened, and next steps DONE! But, it came too late and we now need to work on this change for 2016 (when full year reporting is required). Stage 2 Objective for Patient Electronic Access, measure #2 change threshold from 5% to equal or greater than 1 Stage 2 Objective for Secure Electronic Messaging the threshold changed from % of patients to be a yes/no response DONE! DONE! This change applies to 2015 and 2016! Need to work on fixing it for Fixed for 2015, but changes to at least 1 patient in 2016 & 5% in Not ideal. 34
35 ACP s Stage 3 (draft) Comments it needs to be a bold new world! We believe that CMS has a golden opportunity for a MU do-over MU should aim to fill in key gaps and/or strive to incent optimization of value from health IT (based on specialty and setting of care). MU measures should not be burdensome, and should be built into existing or emerging workflows, such that as care is provided, process or activity measurements can be auto-generated. No measure thresholds!!!! We can learn from all the data submitted. In fact, MU must permit and even encourage flexibility and innovation! CMS and ONC must collaborate with physicians to determine the key tasks that physicians and staff will need to perform better to improve care and help facilitate health IT education. 35
36 How Can ACP Help You to Succeed? 36
37 MIPS or APM? ACP plans to help members choose the right path 1. Advocacy so that whatever path they choose, it gets them to a destination of higher quality, more cost-effective care, without unnecessary obstacles, barriers, potholes, and detours along the way! 2. Education & Resources to help them succeed (e.g. Practice Advisor, Genesis Registry, PQRS Wizard, Timeline) 3. Decision tool (?) to guide them on which path to take, MIPS or APMs 37
38 Critical First Steps Information Gathering and Education (ACP Plans/Activities To Date) Seeking out feedback on the needs/wants of our members: Member panel survey ACP Committee and Council meetings (including the Council of Subspecialty Societies (CSS)) Outreach to other societies and stakeholders Webinars (live and recorded) Slides/speaker notes for use by our Governors and members on MACRA overall and tools/services to help FAQ documents and fact sheets Articles in ACP publications Intent to serve as a warehouse of resources 38
39 Current and Evolving Products ACP online Running a Practice ( Physician & Practice Timeline (text alerts acptimeline to ) ( ne/) ACP Practice Advisor ( will be growing through ACP s CMS Innovation Center Support & Alignment Network (SAN) grant AmericanEHR ( data from physicians for physicians on EHR selection and usability, including MU cert. PQRS Wizard ( Genesis Registry (for PQRS, MU, etc.) - QCDR ( 39
40 Potential MACRA Navigator (MIPS vs. APMs) Potential Product Description Base electronic algorithm practice characteristics, quality measurement experience, quality improvement activities, and readiness Algorithm does NOT result in a single answer but rather analyzes the challenges and opportunities with each option and identifies gap areas (e.g., are you doing care coordination, population management, etc.) The user identifies their pathway and is then directed to tailored resources to help them succeed. ACP resources such as Practice Advisor and Running a Practice Several options for data usage for small practices, integrated groups, consultants, and researchers 40
41 ACP s CMMI Support & Alignment Network (SAN) Grant New Opportunities Transforming Clinical Practice Initiative (TCPI) - Announced by the U.S. Department of Health and Human Services 9/29/2015 Practice Transformation Networks (PTN) 29 Support & Alignment Network (SAN) 10 ACP is one of these!!! ct-sheets/2015-fact-sheets-items/ html 41
42 ACP- TCPI SAN Title - Transforming Clinical Practice: Educating Clinicians, Engaging Patients, Reducing Cost, and Improving Outcomes Timing: 4 Years (re-application each year) Amount: $840,707 year one; if awarded, a total of $2,825,984 over 4 years. Lead Staff: Daisy Smith, Program Manager, and Kelly Pearson Objectives: Broad dissemination and provision of evidence-based practice transformation tools and information Development and dissemination of Transforming Clinical Practice Initiative (TCPI)-aligned modules on the ACP Practice Advisor Evaluation of practice transformation tools and impact 42
43 Additional ideas for ACP s role, particularly re: IM subspecialties, have included MIPS: Play a role in helping ensure the development/ testing/ implementation of guidelines, measures, and clinical practice improvement activities relevant for subspecialties. APMs: Serve as a means of sharing what IM societies are doing to develop APMs, help facilitate opportunities for collaboration/ partnering; potentially create basic tools for APM development. Both MIPS & APMs: Convening of cross-discipline groups to facilitate the development/ implementation of educational opportunities, QI projects, tools and resources to help, etc. in a collaborative way 43
44 Other ideas for how ACP can help are welcome!! 44
45 Questions? 45
MACRA-Impacts on Primary
MACRA-Impacts on Primary Care Providers and Practices Jennifer Bell, MS, Chamber Hill Strategies Mara McDermott, JD, CAPG Shari Erickson, MPH (Moderator), American College of Physicians Macaran Baird,
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationHere is what we know. Here is what you can do. Here is what we are doing.
With the repeal of the sustainable growth rate (SGR) behind us, we are moving into a new era of Medicare physician payment under the Medicare Access and CHIP Reauthorization Act (MACRA). Introducing the
More informationThe Quality Payment Program Overview Fact Sheet
Quality Payment Program The Quality Payment Program Overview Background On October 14, 2016, the Department of Health and Human Services (HHS) issued its final rule with comment period implementing the
More informationKate Goodrich, MD MHS. Director, Center for Clinical Standards & Quality. Center for Medicare and Medicaid Services (CMS) May 6, 2016
Kate Goodrich, MD MHS Director, Center for Clinical Standards & Quality Center for Medicare and Medicaid Services (CMS) May 6, 2016 THE MEDICARE ACCESS & CHIP REAUTHORIZATION ACT OF 2015 Quality Payment
More informationCMS Quality Payment Program: Performance and Reporting Requirements
CMS Quality Payment Program: Performance and Reporting Requirements Session #QU1, February 19, 2017 Kristine Martin Anderson, Executive Vice President, Booz Allen Hamilton Colleen Bruce, Lead Associate,
More informationHealth System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act
Health System Transformation, CMS Priorities, and the Medicare Access and CHIP Reauthorization Act Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services
More informationWELCOME. Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association
WHAT IS MACRA? WELCOME Kate Gainer, PharmD Executive Vice President and CEO Iowa Pharmacy Association WELCOME Anthony Pudlo, PharmD, MBA, BCACP Vice President of Professional Affairs Iowa Pharmacy Association
More informationGetting Ready for the Post-SGR World. Presented by: Sybil R. Green, JD, RPh, MHA. West Virginia Oncology Society Spring Meeting May 5, 2016
Getting Ready for the Post-SGR World Presented by: Sybil R. Green, JD, RPh, MHA West Virginia Oncology Society Spring Meeting May 5, 2016 CME/CE Information For Physicians: This activity has been planned
More informationMACRA Quality Payment Program
The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Understanding the... 3 Navigating MIPS in 2017... 4 MIPS Reporting: Individuals or Groups... 6 2017: The
More informationBackground and Context:
Session Objectives: Practice Transformation: Preparing for a Value Based Purchasing Environment Susan Brown, MPH, CPHIMS May 2, 2016 Understand the timeline and impact of MACRA/MIPS on health care payment
More informationMACRA MACRA MACRA 9/30/2015. From the Congress: A New Medicare Payment System. The Future of Medicare: A Move Toward Value Driven Healthcare W20.
W20.8XXA The Future of Medicare: A Move Toward Value Driven Healthcare Emily L. Graham, RHIA, CCS-P VP, Regulatory Affairs, Hart Health Strategies Consultant, Coalition of State Rheumatology Organizations
More informationHow to Align Quality Reporting Across PQRS, MU, and VBPM
Health Care IT Advisor How to Align Quality Reporting Across PQRS, MU, and VBPM Anantachai (Tony) Panjamapirom Senior Consultant, Health Care IT Advisor Debe Gash CIO, St. Luke s Health System March 10,
More informationCMS Priorities, MACRA and The Quality Payment Program
CMS Priorities, MACRA and The Quality Payment Program Ashby Wolfe, MD, MPP, MPH Chief Medical Officer, Region IX Centers for Medicare and Medicaid Services Presentation on behalf of HSAG November 16, 2016
More information2017 Transition Year Flexibility Improvement Activities Category Options
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Improvement Activities Category Options 1 P a g e Ad MEDICARE
More informationQUALITY PAYMENT PROGRAM
NOTICE OF PROPOSED RULE MAKING Medicare Access and CHIP Reauthorization Act of 2015 QUALITY PAYMENT PROGRAM Executive Summary On April 27, 2016, the Department of Health and Human Services issued a Notice
More informationMACRA The shift to Value Based Care and Payment. Michael Munger, M.D., FAAFP
MACRA The shift to Value Based Care and Payment Michael Munger, M.D., FAAFP Current State Silos of Care Over Utilization Volume over Value Push Towards Value and Quality 85% Medicare Payments tied to quality
More informationStatement for the Record. American College of Physicians. Hearing before the House Energy & Commerce Subcommittee on Health
Statement for the Record American College of Physicians Hearing before the House Energy & Commerce Subcommittee on Health A Permanent Solution to the SGR: The Time Is Now January 21-22, 2015 The American
More informationMACRA Implementation: A Review of the Quality Payment Program
MACRA Implementation: A Review of the Quality Payment Program Neal Logue, Kirk Sadur Centers for Medicare and Medicaid Services, Region IX, September 15, 2017 Disclaimer This presentation was prepared
More informationStatement for the Record. American College of Physicians. U.S. House Committee on Ways and Means Subcommittee on Health
Statement for the Record American College of Physicians U.S. House Committee on Ways and Means Subcommittee on Health Hearing on Implementation of MACRA s Physician Payment Policies March 21, 2018 The
More informationStrategic Implications & Conclusion
Kelly Court Chief Quality Officer Wisconsin Hospital Association Brian Vamstad Government Relations Consultant Gundersen Health System Overview and Key Takeaways of the Medicare Quality Payment Program
More informationMACRA and the Quality Payment Program. Frequently Asked Questions Edition
MACRA and the Quality Payment Program Frequently Asked Questions 2018 Edition What is MACRA?...3 What is the Quality Payment Program?...3 How do payments work under the QPP?...3 What is at risk under
More informationAre physicians ready for macra/qpp?
Are physicians ready for macra/qpp? Results from a KPMG-AMA Survey kpmg.com ama-assn.org Contents Summary Executive Summary 2 Background and Survey Objectives 5 What is MACRA? 5 AMA and KPMG collaboration
More informationDecember 19, Dear Acting Administrator Slavitt:
December 19, 2016 Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Attn: CMS-5517-FC Room 445 G, Hubert H. Humphrey Building 200
More informationMedicare Physician Payment Reform:
Medicare Physician Payment Reform: Implications and Options for Physicians and Hospitals Background The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 14, 2015.
More informationPQRS and Alignment Opportunity: Concept to Operationalization March 1, 2016
PQRS and Alignment Opportunity: Concept to Operationalization March 1, 2016 Debe Gash/ VP & Chief Information Officer/ Saint Luke s Health System Anantachai (Tony) Panjamapirom/ Senior Consultant/ The
More informationAlternative Payment Models and Health IT
Alternative Payment Models and Health IT Health DataPalooza Preconference May 8, 2016 Kelly Cronin, MS, MPH, Director, Office of Care Transformation, ONC/HHS HHS Goals for Medicare Payment Reform In January
More informationFrequently Asked Questions
Frequently Asked Questions What is the Compass Practice Transformation Network (Compass PTN)? The Compass Practice Transformation Network (Compass PTN) was founded by the Iowa Healthcare Collaborative
More informationPractice Transformation Networks
Practice Transformation Networks The project described was supported by Funding Opportunity Number CMS-1L1-15-003 from the U. S. Department of Health & Human Services, Centers for Medicare and Medicaid
More informationOverview of Quality Payment Program
Overview of Quality Payment Program Policies for 2017 & 2018 Performance Years The Medicare program has transformed how it reimburses psychiatrists and other clinicians for providing services, under the
More informationThe Quality Payment Program: Overview & Roles and Responsibilities
The Quality Payment Program: Overview & Roles and Responsibilities National Tribal Health Conference Susy Postal DNP, RN-BC Chief Health Informatics Officer September 27, 2017 INDIAN HEALTH SERVICE / OFFICE
More informationThriving in a Value Based Payment World
Thriving in a Value Based Payment World N.S. Damle MD MS FACP Senior/Managing Partner South County Internal Medicine Assistant Professor of Medicine, Alpert Medical School of Brown University Past Chairman,
More informationQuality Payment Program October 14, 2016
Executive Summary Department of Health and Human Services Centers for Medicare & Medicaid Services 42 CFR Parts 414 and 495 [CMS-5517-FC] RIN 0938-AS69 Medicare Program; Merit-based Incentive Payment System
More informationUnderstanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems
Understanding PQRS and the Value-Based Modifier: CMS Plan to Achieve High Value Care through Transforming Payment Systems Dr. Ashby Wolfe, Chief Medical Officer Centers for Medicare and Medicaid Services,
More informationThe Merit-Based Incentive Payment System (MIPS) Survival Guide. August 11, 2016
The Merit-Based Incentive Payment System (MIPS) Survival Guide August 11, 2016 Speakers Nina Marshall, MSW, Senior Director, Policy and Practice Improvement, National Council for Behavioral Health Elizabeth
More informationUnderstanding Medicare s New Quality Payment Program
Understanding Medicare s New Quality Payment Program Your introduction to MACRA and getting started with MIPS 1 Understanding Medicare s New Quality Payment Program 2016 Mingle Analytics. All Rights Reserved.
More information2017/2018. KPN Health, Inc. Quality Payment Program Solutions Guide. KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc.
2017/2018 KPN Health, Inc. Quality Payment Program Solutions Guide KPN Health, Inc. A CMS Qualified Clinical Data Registry (QCDR) KPN Health, Inc. 214-591-6990 info@kpnhealth.com www.kpnhealth.com 2017/2018
More informationGlossary of Acronyms for the Quality Payment Program
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative Glossary of Acronyms for the Quality Payment Program 1 P a g e MEDICARE QPP PHYSICIAN EDUCATION
More informationMACRA Quality Payment Program
The American College of Surgeons Resources for the New Medicare Physician System Table of Contents Simple Steps to Determine If MIPS Applies to Your Practice Situation... 3 5 Understanding the... 6 7 Big
More informationCenters for Medicare & Medicaid Services: Innovation Center New Direction
Centers for Medicare & Medicaid Services: Innovation Center New Direction I. Background One of the most important goals at CMS is fostering an affordable, accessible healthcare system that puts patients
More informationACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT
ACCOUNTABLE CARE ORGANIZATION & ALTERNATIVE PAYMENT MODEL SUMMIT The Centers for Medicare and Medicaid Services Kate Goodrich, MD MHS Director, Clinical Standards & Quality Chief Medical Officer 1 DISCLAIMERS
More informationThe Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization. Quality Forum August 19, 2015
The Evolving Landscape of Healthcare Payment: Incentive Programs and ACO Model Optimization Quality Forum August 19, 2015 Ross Manson rmanson@eidebailly.com 701.239.8634 Barb Pritchard bpritchard@eidebailly.com
More informationMACRA WHAT DOES IT MEAN FOR YOUR PRACTICE?
MACRA WHAT DOES IT MEAN FOR YOUR PRACTICE? A Presentation for ASMA and MIEC Members & Guests Copyrighted 2017, The Sage Associates, Pismo Beach, California All rights reserved. All material contained in
More informationQUALITY PAYMENT PROGRAM YEAR 2 CY 2018 PROPOSED RULE Improvement Activities Component Reporting Requirements. No change.
QUALITY PAYMENT PROGRAM YEAR 2 CY 2018 PROPOSED RULE Improvement Activities Component Reporting Requirements Brief Synopsis: The Improvement Activities (IA) performance category will continue to comprise
More informationMIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD
MIPS Collaborative: Clinical Practice Improvement Activities April 19, 2017 Francis R Colangelo, MD Outline of Presentation Introduction Overview of MACRA/MIPS Clinical Practice Improvement Activities
More informationMACRA for Critical Access Hospitals. Tuesday, July 26, 2016 Webinar
MACRA for Critical Access Hospitals Tuesday, July 26, 2016 Webinar MACRA presenters Harold D. Miller, President & CEO CHQPR Claudia Sanders, Sr. Vice President, Policy Development Andrew Busz, Policy Director,
More informationOsteopathic Advocacy: Partnering to Advance Sound Health Policy. Nicholas Schilligo, MS Associate Vice President, State Government Affairs
Osteopathic Advocacy: Partnering to Advance Sound Health Policy Nicholas Schilligo, MS Associate Vice President, State Government Affairs Our Work Work with a variety of stakeholders to promote AOA policies
More informationAlternative Payment Model Environment Implications for Specialty Providers and their Partners
Alternative Payment Model Environment Implications for Specialty Providers and their Partners Bob Dowling MD Vice President Medical Affairs and Policy ION Solutions/IntrinsiQ Specialty Solutions June 20,
More informationCenters for Medicare & Medicaid Services: Innovation Center New Direction Request for Information
November 20, 2017 Seema Verma Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Room 445 G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington,
More informationMACRA Frequently Asked Questions
Following the release of the Quality Payment Program Interim Final Rule, the American Medical Association (AMA) conducted numerous informational and training sessions for physicians and medical societies.
More informationMIPS, MACRA, & CJR: Medicare Payment Transformation. Presenter: Thomas Barber, M.D. May 31, 2016
MIPS, MACRA, & CJR: Medicare Payment Transformation Presenter: Thomas Barber, M.D. May 31, 2016 Michael Porter- Value Based Care Delivery, Annals of Surgery 2008 Principals: Define Value as a Goal Care
More informationFrom Surviving to Thriving in the QPP World
From Surviving to Thriving in the QPP World Today s Objectives Brief MACRA Overview Where are we going?: Advanced Alternative Payment Models (APMs) Where are we now? Merit Incentive-Based Payment System
More informationCMS: Delivery System Reform
CMS: Delivery System Reform Session #6, February 20, 2017 Pierre Yong, Director, Quality Measurement and Value-Based Incentives Group, Centers for Clinical Standards and Quality, Centers for Medicare &
More informationPassage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): The Doc Fix
April, 2015 Passage of Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): The Doc Fix Author: Annemarie Wouters, Senior Advisor The President has signed into law the bipartisan bill H.R. 2,
More informationMedicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians
Medicare Quality Payment Program: Deep Dive FAQs for 2017 Performance Year Hospital-Employed Physicians This document supplements the AMA s MIPS Action Plan 10 Key Steps for 2017 and provides additional
More informationSVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation
SVS QUALITY AND PERFORMANCE MEASURES COMMITTEE (QPMC) New Member Orientation 2017-2018 SVS QPMC Quality and Performance Measures Committee Policy and Advocacy Council (Chair Sean Roddy) Chair: Brad Johnson,
More informationThank You to Our Sponsor!
AMCP Webinar Emerging Physician Payment Models: What Does it Mean for AMCP Members and Medication Management? April 19, 2017 Thank You to Our Sponsor! 1 Disclaimer Organizations may not re use material
More informationMarch Data Jam: Using Data to Prepare for the MACRA Quality Payment Program
March Data Jam: Using Data to Prepare for the MACRA Quality Payment Program Elizabeth Arend, MPH Quality Improvement Advisor National Council for Behavioral Health CMS Change Package: Primary and Secondary
More informationNorthern New England Practice Transformation Network (NNE-PTN)
Northern New England Practice Transformation Network (NNE-PTN) Introduction & Overview November 2015 Today s Presenters Lisa Letourneau, MD, MPH Executive Director Maine Quality Counts Catherine Fulton,
More informationPerspectives on Primary Care Transformation: Measurement, MACRA, Medical Homes, and Payment Reform
Perspectives on Primary Care Transformation: Measurement, MACRA, Medical Homes, and Payment Reform Robert A. Berenson, MD Institute Fellow, the Urban Institute rberenson@urban.org Covered California Stakeholder
More informationSubmitted electronically:
Mr. Andy Slavitt Acting Administrator Centers for Medicare and Medicaid Services Department of Health and Human Services Attention: CMS-5517-FC P.O. Box 8013 7500 Security Boulevard Baltimore, MD 21244-8013
More informationMACRA Fall into Place. By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof
MACRA Fall into Place By Stephanie Cecchini, CPC, CEMC, CHISP, AAPC Fellow, AAPC MACRA Prof About the Presenter https://www.linkedin.com/in/stephaniececchini 2 Introduction Love it Hate it Don t know a
More informationQuality Payment Program MIPS. Advanced APMs. Quality Payment Program
Proposed Rule: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models The Department
More informationWhat s Next for CMS Innovation Center?
What s Next for CMS Innovation Center? A Guide to Building Successful Value-Based Payment Models Given CMMI s New Focus on Voluntary, Home-Grown Initiatives W W W. H E A L T H M A N A G E M E N T. C O
More informationMACRA: Disrupting the health care system at every level
Health Policy Brief MACRA: Disrupting the health care system at every level Produced by the Deloitte Center for Health Solutions and the Deloitte Center for Regulatory Strategies Executive summary The
More informationValue-Based Psychiatric Care
Value-Based Psychiatric Care North Carolina Psychiatric Association Annual Meeting September 15, 2017 Grace E. Terrell, MD Mission: To be your medical home Vision: To be the model for physician-led health
More informationMIPS Checkpoint. Beth Hickerson Quality Improvement Advisor. PHA Lunch and Learn May 19, Value Driven. Health Care. Solutions.
MIPS Checkpoint Beth Hickerson Quality Improvement Advisor PHA Lunch and Learn May 19, 2017 Check Your MIPS Eligibility QPP.CMS.GOV 2 MIPS Category Weights Over Time : Quality Advancing Care Information
More informationThe Influence of Health Policy on Clinical Practice. Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center
The Influence of Health Policy on Clinical Practice Dr. Kim Kuebler, DNP, APRN, ANP-BC Multiple Chronic Conditions Resource Center Disclaimer Director: Multiple Chronic Conditions Resource Center www.multiplechronicconditions.org
More informationCMS* Priorities and the Medicare Access and CHIP Reauthorization Act
CMS* Priorities and the Medicare Access and CHIP Reauthorization Act Howard Pitluk, MD, MPH, FACS Vice President Medical Affairs and Chief Medical Officer June 4, 2016 *Centers for Medicare & Medicaid
More informationMACRA Open Call December 5 th, 2016
MACRA Open Call December 5 th, 2016 Leila Volinsky, MHA, MSN, RN Quality Reporting Program Administrator This material was prepared by the New England QIN-QIO, the Medicare Quality Innovation Network-Quality
More informationAgenda. Surviving the New Program Requirements and the Financial Penalties Under MIPS 9/9/2016. Steps to take to prepare for MIPS
Surviving the New Program Requirements and the Financial Penalties Under MIPS September 2016 Selena Hood Agenda Steps to take to prepare for MIPS Introduction and Evaluation of the Merit-Based Incentive
More informationPhysician Quality Reporting System & VBPM, 2015
Physician Quality Reporting System & VBPM, 2015 Andrew Bienstock Transformation Support Services Manager 1 Agenda 1. PQRS Penalty 2. PQRS Eligibility 3. PQRS Reporting Options 4. Value Based Payment Modifier
More informationMarch 6, Dear Administrator Verma,
March 6, 2018 Seema Verma Administrator Centers for Medicare and Medicaid Services U.S. Department of Health and Human Services Room 445 G, Hubert H. Humphrey Building 200 Independence Avenue SW Washington,
More informationPopulation Health Management. Ashley Rhude RHIA, CHTS-IM HIT Practice Advisor
Population Health Management Ashley Rhude RHIA, CHTS-IM HIT Practice Advisor Mission of OFMQ OFMQ is a not-for-profit, consulting company dedicated to advancing healthcare quality. Since 1972, we ve been
More informationComments to the CMS Request for Information, Merit-based Incentive Payment System and Promotion of Alternative Payment Models
November 16, 2015 Centers for Medicare & Medicaid Services Department of Health and Human Services Hubert H. Humphrey Building 200 Independence Ave., SW Washington, DC 20201 Attention: CMS 3321- NC Comments
More informationPopulation Health and the Accelerating Leap to Outcomes-Based Reimbursement. Craig J. Wilson
Population Health and the Accelerating Leap to Outcomes-Based Reimbursement Craig J. Wilson Agenda / Goals Define Population Health Management Review emerging reimbursement landscape eg MACRA Review why
More informationStage 3 and ACI s Relationship to Medicaid MU Massachusetts Medicaid EHR Incentive Program
Stage 3 and ACI s Relationship to Medicaid MU Massachusetts Medicaid EHR Incentive Program September 19 & 20, 2017 Today s presenters: Brendan Gallagher Thomas Bennett Agenda Stage 3 Meaningful Use (MU)
More informationConnected Care Partners
Connected Care Partners Our Discussion Today Introducing the Connected Care Partners CIN What is a Clinically Integrated Network (CIN) and why is the time right to join the Connected Care Partners CIN?
More informationMACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care
MACRA is Coming: Reimbursement for Quality and the Shift to Population-Based Care AMERICAN NEUROLOGICAL ASSOCIATION October 17, 2017 Marc R. Nuwer, MD PhD Professor and Vice Chair UCLA Lyell K. Jones,
More informationESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM. Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017
ESSENTIAL STRATEGIES IN MEDI-CAL PAYMENT REFORM Richard Popper, Director, Medicaid & Duals Strategy August 3, 2017 1 DISCLAIMER The enclosed materials are highly sensitive, proprietary and confidential.
More informationVALUE BASED ORTHOPEDIC CARE
VALUE BASED ORTHOPEDIC CARE Becker's 14th Annual Spine, Orthopedic and Pain Management- Driven ASC Conference + The Future of Spine June 9-11, 2016 Swissotel, Chicago, IL LES JEBSON Administrator, Adjunct
More informationThe Healthcare Roundtable
The Healthcare Roundtable MACRA Update Jayme R. Matchinski Greensfelder, Hemker & Gale, P.C. April 7, 2017 New Orleans, Louisiana This presentation and outline are limited to a discussion of general principles
More information2017 Transition Year Flexibility Advancing Care Information (ACI) Category Options
The Physicians Advocacy Institute s Medicare Quality Payment Program (QPP) Physician Education Initiative 2017 Transition Year Flexibility Advancing Care Information (ACI) Category Options Ad 1 P a g e
More informationMIPS Deep Dive: 9 steps to Reporting. Sharon Phelps QPP Webinar Series Webinar 4 June 20, 2017
MIPS Deep Dive: 9 steps to Reporting Sharon Phelps QPP Webinar Series Webinar 4 June 20, 2017 HealthInsight Our business is redesigning health care systems for the better HealthInsight is a private, non-profit,
More informationMACRA & Implications for Telemedicine. June 20, 2016
MACRA & Implications for Telemedicine June 20, 2016 Presentation Overview Introductions Deep Dive Into MACRA Implications for Telemedicine Questions Growth in Value-Based Care Over Next Two Years Growth
More informationCHIA PRESENTATION HANDOUT
5055 E. McKinley Ave, Fresno CA 95407 Tel: (559) 251 5038 Info@ CHIA PRESENTATION HANDOUT 2018 CHIA CONVENTION & EXHIBIT SAN DIEGO, CA MACRA and HIM Doing the Impossible Presented by: Moshe Starkman Presented
More informationObjectives. Preparing for Value-Based Reimbursement 3/28/2016
Preparing for Value-Based Reimbursement Tracy Bird, FACMPE, CPC, CPMA, CPC-I, CEMC Sr. Advisor Education and Consulting KaMMCO April 12, 2016 1 2 Objectives A look back - how did we get here Existing and
More informationMeaningful Use Under MIPS
Meaningful Use Under MIPS July 20, 2016 Agenda Opening Remarks Housekeeping Polling Question Presentations Q&A Polling Question Closing Remarks 2 Introduction to the atom Alliance Multi-state alliance
More informationMACRA and MIPS. How Medicare Meaningful Use and PQRS are Changing
MACRA and MIPS How Medicare Meaningful Use and PQRS are Changing Link to recorded session: https://attendee.gotowebinar.com/recording/1305549490878052097 Presenting Today: Molly Goodhart Joined Quatris
More informationThe New Frontier: Value- Based Payment Models
The New Frontier: Value- Based Payment Models Target Audience: Pharmacists and Pharmacy Technicians ACPE#: 0202-0000-18-026-L04-P/T Activity Type: Knowledge-based Target Audience: ACPE#: Activity Type:
More informationThe Future of Physician Reimbursement
The Future of Physician Reimbursement EBG (PQRS-Quality Measures) yield Outcome Report Yield Increased Quality Yield Decreased Cost yield Increased Patient Satisfaction - CAHPS Consumer Assessment of Healthcare
More informationMaking Sense of What s Next: Value Based P4P Measurement & MACRA. Mike Weiss, DO September 23, 2016
Making Sense of What s Next: Value Based P4P Measurement & MACRA Mike Weiss, DO September 23, 2016 Making Sense of What s Next in VBP4P Background Drivers and Imperatives 2016-2021 Measure Set Strategy
More informationAdvancing Care Information- The New Meaningful Use September 2017
Advancing Care Information- The New Meaningful Use September 2017 ACO Announcements Reminders: ACO Notifications PECOS-Maintain active enrollment 2017 Patient Prospective Lists Upcoming provider/office
More informationCenters for Medicare and Medicaid CMS Updates. Christol Green, Anthem Inc.
Centers for Medicare and Medicaid CMS 2016-2017 Updates Christol Green, Anthem Inc. Agenda Topic Page Payment Models - BPCI 3 Sequestration 5 CPC+ Initiative 7 What is MACRA? 12 CMS Social Security Number
More informationMACRA, MIPS, QPP, and APMs.
MACRA, MIPS, QPP, and APMs. The acronym soup of moving from volume to value. Dale W. Bratzler, DO, MPH, MACOI, FIDSA Edith Kinney Gaylord Presidential Professor Professor, Colleges of Medicine and Public
More informationMACRA, QPP, MIPS... more alphabet soup anyone?
A Partner for Lifelong Health Cathy Cordova, MPS, BSN, RN, CPHIMS Director, Clinical Excellence and Value Donna McCarthy, MT (ASCP), MBA Meaningful Use Manager MACRA, QPP, MIPS... more alphabet soup anyone?
More informationUPDATED WITH FINAL RULE NOVEMBER 11, Preparing for Success With MACRA
UPDATED WITH FINAL RULE NOVEMBER 11, 2016 G A M E C H A N G E R : Preparing for Success With MACRA Overview The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) dramatically impacts the way
More informationRecent Legislative Changes: MU, PQRS, and MIPS
Recent Legislative Changes: MU, PQRS, and MIPS Catherine Chuter Sr. Associate, athenahealth This event is live as of XYZ 2 Projected number of Medicare beneficiaries Source: CMS, 2013 Annual Report of
More informationMACRA FLEXIBILITY & THE MACRA FINAL RULE. Compliance & Opportunity for Your Practice
MACRA FLEXIBILITY & THE MACRA FINAL RULE Compliance & Opportunity for Your Practice CONTENTS Overview... 5 What s new... 5 Advancing Care Information... 8 Major changes... 9 Proposed rule vs. final rule
More informationMoving the Dial on Quality
Moving the Dial on Quality Washington State Medical Oncology Society November 1, 2013 Nancy L. Fisher, MD, MPH CMO, Region X Centers for Medicare and Medicaid Serving Alaska, Idaho, Oregon, Washington
More information