MACRA Update: The Top 8 For 2018 Amy Mullins, MD, CPE, FAAFP Medical Director, Quality Improvement AAFP
Disclosure Statement It is the policy of the AAFP that all individuals in a position to control content disclose any relationships with commercial interests upon nomination/invitation of participation. Disclosure documents are reviewed for potential conflicts of interest. If conflicts are identified, they are resolved prior to confirmation of participation. Only participants who have no conflict of interest or who agree to an identified resolution process prior to their participation were involved in this CME activity. All individuals in a position to control content for this session have indicated they have no relevant financial relationships to disclose.
4 MACRA
5 April 16, 2015
Medicare Access and CHIP Reauthorization Act NOT: M- Making A- All C- Clinicians R- Really A- Angry 6
MACRA vs. Quality Payment Program (QPP) Merit Based Incentive Payment System (MIPS) Advanced Alternative Payment Models (AAPMs) 7
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9 This Photo by Unknown Author is licensed under CC BY-SA
Primary Care Advanced APMs Shared Savings Program (Tracks 2 & 3) Next Generation ACO Model Comprehensive Primary Care Plus (CPC+) Vermont Medicare ACO Initiative (as part of the Vermont All-Payer ACO Model) *AAPMs announce as approved 10
Advanced APM Perks Not Subject to MIPS 5% bonus payment years 2019-2024 (performance years 2017-2022) Higher fee schedule update 2026 and onward (0.75% vs 0.25%) 7 6 5 4 3 2 1 0 PFS Update 2026 and Onward AAPM All Others 1 2 3 4 5 6 7 8 9 Series1 Series2 11
MIPS Performance Categories Quality Cost Advancing Care Improvement Activities Information/ Promoting Interoperability 12
Weighting Progression 2017 2018 2019 Quality 60% 50% 50-30% Cost 0% 10% 10-30% Advancing Care Information/Promoting Interoperability 25% 25% 25% Improvement Activities 15% 15% 15%
AES Question
Question #1 How will are you participating in QPP in performance year 2018? A. MIPS B. AAPM C. I m Exempt D. Don t Know 15
Update #1 Low-volume Threshold 16
Low- volume Threshold 2017: <100 Medicare Part B beneficiaries, or received $30,000 or less in Medicare Part B payments 2018: <200 Medicare Part B beneficiaries, or received $90,000 or less in Medicare Part B payments (excludes Part B drugs*) *added by the budget reconciliation bill passed in February 2018 17
18 Low-volume Threshold
Low-volume Threshold The Centers for Medicare and Medicaid Services (CMS) has published a CMS Look- Up Tool for clinicians to verify their MIPSeligibility status by entering their National Provider Identifier (NPI) number qpp.cms.gov 19
Update #2 Virtual Groups 20
Virtual Groups The deadline to sign up to participate as a virtual group for the 2019 performance period is December 31, 2018. 21
Virtual Groups Those who fall below the lowvolume threshold can participate in virtual groups, but they will not receive a positive or negative payment adjustment. 22
Update #3 Cost 23
Cost 2017: Cost 0% of the MIPS final score 2018: Cost accounts for 10% MIPS final score 2019-2021*: Cost will account for 10-30% for the MIPS final score Cost category continues to require no data submission from physicians Quality 2017: 60% 2018: 50% 2019-21: 50-30% Cost 2017: 0% 2018: 10% 2019-21: 10-30% *Changed due to budget reconciliation passed February 2018; Percentage determined by the Secretary of HHS 24
Update #4 Performance Period 25
Performance Period 2017- Pick Your Pace 2018- Quality/Cost (full year); ACI/IA (90 days) Quality/Cost Performance Period Feedback Available 2019 ACI/IA Performance Period Data Submission Deadline 3/31/2019 Payment Adjustment 1/1/2020 26
Update #5 Improvement Activities (IA) and PCMH 27
AES Question
Question Are you a recognized/certified PCMH? A. Yes B. No 29
IA and PCMH 2017: One member of the TIN could have PCMH recognition for 100% IA credit for the TIN 2018: 50% of TIN practice sites need PCMH recognition for the TIN to receive full IA credit 30
IA and PCMH Recognized/Certified still defined as: NCQA, AAAHC, TJC, URAC, and accrediting bodies that have certified 500 or more practices IA still accounts for 15% of the MIPS final score 31
Update #6 Bonus Points 32
Small Practice Bonus Points Small Practice: 15 or fewer Five points added to the MIPS FINAL score Must submit data in at least one MIPS category to qualify for bonus 33
Complex Patient Bonus + x = 34
Complex Patient Bonus Added to the final MIPS score + x = =.20 35
Update #7 Performance Threshold 36
Performance Threshold Exceptional Performance: 70 Performance Threshold in 2018: 15 Performance Threshold in 2017: 3 New provision: The Secretary may set the Performance Threshold for program years 2019, 2020 and 2021 (it will gradually increase) 37
38 Adjustment will not apply to Part B Drugs
Update #8 Employed Physicians and Residents 39
Employed Physicians and Residents MIPS scores follow you MIPS scores are publicly available Consider a practices MIPS score as you evaluate employment contracts *More information in the FPM Employed Physician Supplement 40
Best Practice Recommendations Find your available resources: aafp.org/macraready qpp.cms.gov FPM QPP Service Center: 866-288-8292 41
MIPS Playbook Step-by-Step guide to help: Understand MIPS reporting requirements Provides checklists and actionable steps Prepare for successful performance in QPP Available (free for members) at www.aafp.org/macraready 42