MACRA

Medicare Access and CHIP Reauthorization Act

MACRA

THREE MAJOR CHANGESEnding the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.

Making a new framework for rewarding health care providers for giving better care not just more care

Combining the existing quality reporting programs into one new system.

1

2

3

These changes create the:

QUALITY PAYMENT PROGRAM

TWO TRACKS FOR CLINICIANS TO CHOOSE FOR REPORTING

MIPSMerit-based Incentive System APMs

AlternativePaymentModels

MIPS

MIPS is a new program which combines the Physician Quality Reporting System, Value Modifier and Meaningful Use programs into one program.

MU PQRS VM MIPS

Clinicians receive a composite score based on their performance in these 4 areas:

MIPS

= MIPS Composite Performance Score

Quality Improvement

Activities

AdvancingCare

InformationCost*+ + +

*Starts in 2018

MIPS Performance Categories

60%Quality

Replaces the Physician Quality Reporting System (PQRS)

MIPS Performance Categories

25%ImprovementActivities

New Category

MIPS Performance Categories

15%Advancing CareInformation

Replaces the Medicare EHR Incentive Program (Meaningful Use)

MIPS Performance Categories

0%Cost

Replaces the Value-Based Modifier (STARTS IN 2018)

COMPOSITE PERFORMANCE SCORE BREAKDOWN:

Quality

Improvement Activities

Advancing Care Information

Cost

60%

25%

15%

APMs

An APM is a payment approach that provides added incentives to clinicians to provide high-quality, cost-efficient care.

Most providers who participate in APMs will also be subject to MIPS.

APMs

Advanced APMs are not subject to MIPS.

Advanced APMs include:

• Accountable Care Organizations (ACOs)

• Patient Centered Medical Homes

• Bundled Payment Models

Very few health systems will fall into this category

APMs

Almost everyone reports under MIPS in 2017

Whether you are taking the MIPS or APM track the majority will report for MIPS.

Exclusions:• New to Medicare• Very low Medicare billing volume• Qualified for advanced APM status

REPORTING OPTIONS

Don’t Participate

Don’t send any 2017 data to Medicare.

Receive a -4% payment adjustment.

Option 1

Testthe Quality Reporting Program

Option 1

Submit SomethingSubmit a minimum amount of 2017 data to Medicare.

For example, one quality measure or one improvement activity.

Option 1

If completed,you’ll avoid a negative adjustment.

Participate for part of the calendar year

Option 2

Option 2

Submit 90 days of 2017 data to Medicare.

• You can start later than January 1, 2017• Select from the list of quality measures and

improvement activities in MIPS

Option 2

If completed, you could still qualify for a small positive payment adjustment.

Option 3

Participate for the fullcalendar year

Option 3

Submit a full year of 2017 data to Medicare.

• First performance period begins January 1, 2017

Option 3

If completed, you could qualify for a “modest positive payment adjustment.”

Option 4 Option 4

Participate in an Advanced Alternative Payment Model in 2017

Option 4

Requirements to participate in Advanced APM

Medicare payments through Advanced APM

Medicare patients through Advanced APM

25% 20%

Option 4

If qualified, you will receive a +5% incentive payment in 2019.

To learn more about MACRA as it progresses check back with

Medisolv at Medisolv.com

www.medisolv.com | (844) 633-4675 | info@medisolv.com