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10 Things You Need to Know About MIPS and APM
Emily JamesManager Meaningful Use Performance
• Medicare Access and CHIP Reauthorization Act (MACRA) signed into law April 16th, 2015
• Repealed the flawed sustainable growth rate (SGR) formula
• Extends Children’s Health Insurance Program (CHIP) for two years
• New two-track Medicare physician payment system emphasizing value-based payment models
Landmark legislation alters howMedicare reimburses physicians
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MU PQRS VMMIPSMerit-Based Incentive Payment
System
Consolidates three existing programs, adds in additional performance category
APMAlternative Payment Models
Incentive payments available to qualified and eligible APM
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1 When do I start?
“The folks at CMS are very smart and well meaning, but it’s hard for me to imagine implementing the NPRM as written in the timeframes suggested.”
-John Halamka, MD, MSCIO Beth Israel Deaconess Medical Center
Dean for Technology Harvard Medical School6
Nov 2016:CMS to release final rule
May 2016:You start now Jan 1st 2017:
QPP proposed ruling to begin
Learning
Preparing
Performing
Reporting
8 months
2 Who is eligible?
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MIPS APM• Next Generation
ACO• Comprehensive
Primary Care Plus (CPC+)
• Medicare Shared Savings Program (MSSP) Tracks 2 & 3
• Oncology Care Model with two-sided risk
• Comprehensive ESRD Care (for larger dialysis organizations)
• Physicians• PAs• NPs• Clinical nurse
specialists• CRNs• Anesthetists• Groups that
include such clinicians
3 Which track do I choose?
Everyone reports MIPS
in 2017.
4 What is the reporting period?
5 What are the MIPS payment adjustments?
-1% +1%
Maximum Provider Penalties and Bonuses
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30%
20%
10%
0%
-10%
Paym
ent A
djus
tmen
t
-4%4%
12%
2019
-5%
5%
15%
2020
-7%
7%
21%
2021
-9%
9%
27%
2022
High performers eligible
for additional incentive
Budget neutrality adjustment: Scaling factor up to 3x may be applied to upward adjustment to ensure payout pool equals penalty pool
Non-reporting
groups given lowest score
6 Then, what will my payment adjustment be?
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87% of solo practitioners are
expected to see a negative
adjustment.
7 What about APMs?
Bundled PaymentsPCMHMSSP Tracks 2 and 3 (TIN)
Oncology Care Model (OCM) one-sided risk arrangement
CMS Innovation Center initiativesNext Generation ACO (EC Level)
Comprehensive Primary Care Plus (CPC+)
Oncology Care Model (OCM) two-sided risk arrangement
Comprehensive ESRD Care (CEC) (LDO arrangement)
MSSP Track 1 (TIN)Comprehensive ESRD Care (CEC) (non-LDO arrangement) ?
8 What will this cost?
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$723.50total estimated annual cost per MIPS eligible
clinician.
11 burden hoursper MIPS EC for EHR data
submission.(for Quality Performance category alone)
9 So, Meaningful Use is gone?
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MU
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Last, but not least…
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$4.8 billionCollections posted per
quarter
195,900+Active interfaces
78,158Providers on our network
69 million Patient records1.2 billion
Data transactions processed annually
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4,752employees
8locations
5services
Specialized teams at athenahealth all across the
country have your back
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Our web-based solution offers visibility into our clients’ performance, with network-wide adjustments
We’ve optimized the quality measure selection through an automatic model
We will do your MIPS and APM reporting for you
We’ve done this before: we lead the industry with our clients’ success in MU and PQRS
1 We’ve already started to estimate our current clients’ performance
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Currently estimating our clients’ performance in real-time
athenaNet provider performance on Meaningful Use Stage 2 measure: Use Secure Electronic Messaging
NETWORK WIDE CHANGES:1. NEW FUNCTION: Now easier for practices to
register patients to the patient portal.2. FUNCTION UPDATE: Now easier for providers
to send patients secure messages through the patient portal.
100%
90%
80%
70%
OCT. 2014 NOV. 2014 DEC. 2014
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$723.50
saved
11burden hours saved
We will take on your busy work
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We will make sense of the 200 measures and choose which are right for
you
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Historically, our clients perform better.
Meaningful Use Stage 2 attestation
% of HCPs avoidingPQRS penalties in 2015
NATIONAL AVERAGE
60%ATHENAHEALTH
CLIENTS
93.6%NATIONAL AVERAGE
33%ATHENAHEALTH
CLIENTS
98.2%
Want more? Join Us!
MIPS Deep DiveWednesday June 1st
Hosted by Ruby MaaSenior Product Innovation Association
Thank You