MACRA Open Call December 5 th, 2016

Transcription

1 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 Improvement Organization for New England, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. CMSMA_D1_201611_0804

2 Acronyms APM Alternative Payment Models QPP Quality Payment Program EHR Electronic Health Record MACRA Medicare Access & CHIP Reauthorization Act MIPS - Merit-Based Incentive Payment System IA Improvement Activities MU Meaningful Use EC Eligible Clinician PQRS Physician Quality Reporting System QRUR Quality Resource & Use Reports TIN Tax Identification Number VBM Value Based Modifier ACI Advancing Care Information 2

3 Medicare Access and CHIP Reauthorization Act MACRA (2015) Put into place several changes to provider payment systems, specifically as a means for repealing the sustainable growth rate (SGR) in an effort to reduce Medicare spending Created the Quality Payment Program, which includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) These programs extend various opportunities for providers to receive payment incentives and penalties based on performance 12/2/2016 3

4 Merit-based Incentive Payment System (MIPS) MIPS consolidates several physician quality reporting and payment programs, which includes: Physician Quality Reporting System (PQRS) Meaningful Use (MU) Value-based Payment Modifier (VBPM) Providers will be eligible for payment incentives as well as penalties based on performance in the categories of: Quality (50% of MIPS score) Advancing Care Information (25% of MIPS score) Improvement Activities (15% of MIPS score) Cost (0% of MIPS score not reported in 2017) 12/2/2016 4

5 Alternative Payment Models (APMs) In an APM, providers accept both risk and reward for providing coordinated, high-quality and efficient care Providers are eligible for a 5% incentive payment and may be excluded from the MIPS program Who is excluded from MIPS? Providers in qualified advanced APMs, which include the following APM structures and requires over 25% of provider claims to be submitted through the APM Accountable Care Organizations (Medicare Shared Savings Tracks 2 and 3 or Next Generation ACOs) Comprehensive Primary Care Plus (CPC+) Comprehensive End-Stage Renal Disease Model Oncology Care Model 12/2/2016 5

6 Eligibility and Exclusion Criteria Who is eligible for MIPS? What is the low-volume exclusion? Clinicians that submit less than $30,000 in Medicare Part B claims annually OR Care for fewer than 100 Medicare patients annually are excluded from MIPS Clinicians in their first year of submitting Medicare claims or who are participating in an advanced APM* are also excluded from MIPS 12/2/2016 6

7 MIPS Program 2017 is a transitional year Clinicians will be required to report on three of the four performance categories Quality Advancing Care Information Improvement Activities Cost will be scored at 0% for /2/2016 7

8 Pick Your Pace For Reporting 12/2/2016 8

9 Need Help Navigating the Quality Payment Program? Let the QIN-QIO lead the way! Access to brief, no-cost CMS learning modules on topics ranging from choosing quality measures to MIPS scoring methodology Individual, personalized technical assistance for providers and practices assistance with meeting the MIPS performance category requirements MIPS/APMs Boot Camp Toolkit use our readiness assessment to identify how successful you may be with the MIPS program; check our acronym cheat sheet to help with the MACRA alphabet soup Visit our website for additional resources /2/2016 9

10 Resources New England QIN-QIO MACRA website - itiatives/macra/ Ask A Question ives/macra/ask-question/ CMS Quality Payment Program website 12/2/

11 Contact Information Leila Volinsky, MHA, MSN, RN Quality Reporting Program Administrator ext