What is MACRA?

The law that starting in 2019 will replace the Sustainable Growth Rate Model with a value-based system with the goal of creating a different more sustainable payment system for providers and physicians.

What is the Quality Payment Program (QPP)?

Payment program that will be used to implement MACRA in the proposed rule to be released April 27, 2016. This program will end the sustainable growth rate formula and add two tracks:

  • Advanced Alternative Payment Models (APMs) or

  • The Merit-based incentive Payment System

Who Participates in the QPP?

You qualify if you:

  • Bill Medicare for more than $30,000 in Part B allowed charges a year and provide care for more than 100 Medicare patients a year

  • Are and Advanced APM

To Participate in MIPS track of QPP you also have to be:

  • Physician

  • Physician assistant

  • Nurse practitioner

  • Clinical nurse specialist

  • Certified registered nurse anesthetist

Who Is Impacted by the QPP?

Clinicians who bill Medicare Part B will be impacted by the Quality Payment Program.

Are There Exemptions?

There are many exemptions for eligible providers:

  • If you are participating in Advanced APM

  • If you see less than 100 Medicare patients each year

  • If you are in your first year of Medicare for 2017.

  • If you bill $30,000 or less in Medicare.

What Qualifies as an Advanced APM?

  • Next Generation ACO Model

  • Comprehensive ESRD Care (CEC) Model - Two-Sided Risk

  • Comprehensive Primary Care Plus (CPC+) Model

  • CPC+ only: Eligible clinicians were assessed only as part of their CPC+ Practice group.

  • CPC+ and Medicare Shared Savings Program (Shared Savings Program) Tracks 2 or 3: Eligible clinicians were assessed only as part of their Shared Savings Program Track 2 or 3 ACO.

  • Medicare Shared Savings Program - Track 2

  • Medicare Shared Savings Program - Track 3

What Are the Performance Categories for MIPS?

Quality, Resource Use, Clinical practice improvement activities, advancing care information.

Do you Need a Certified EHR to Participate in the QPP?

To participate in MACRA, you would need a certified EHR. For 2017, the EHR has to be 2014, or 2015 certified.

How Do I Find Out If My EHR Is Certified??

Check with your vendor to see if your EHR is 2014 Edition certified to meet the requirements set for 2017. You can go to www.healthit.gov to search the lists of certified EHRs.

What Is the Quality Requirement for MIPS?

There are six measures to report to CMS that best reflect their practice. One of the measures must be an outcome measure or a high-priority measure and one must be a cross cutting measure. There is also an option for clinicians to report a speciality measure set.

How Many Measures Are There to Choose from for Quality?

MIPS features 217 quality measures for clinicians to choose from.

What Are the Improvement Activity Requirements for MIPS?

Improvement activities were created to improve patient access and patient experience. There is a lot of flexibility available to clinicians with 93 activities from which to choose. This category comprises of 15% of the aggregate MIPs score.

How Many Improvement Activities Are There to Choose From?

There are 93 different improvement activities that are broken into 8 domains. The domains are:

  • Beneficiary Engagement

  • Patient Safety & Practice Assessment

  • Population Management

  • Care Coordination

  • Behavior and Mental Health

  • Achieving Health Equity

  • Expanded Practice Access

  • Emergency Response & Preparedness

What Is the Advancing Care Information Requirement for MIPS?

This category dictates how clinicians will report key measures of interoperability and information exchange. It is a simplified version of the meaningful use program. Clinician are rewarded for their performance on measures that matter most to them.

How Many Measures Are There to Choose from for Advancing Care Information?

There are five measures required for the base score during the 2017 MIPs transition year in order for eligible clinician to avoid the negative adjustment. These five measures include:

  • ePrescribing

  • Patient Access

  • Security Risk Assessment

  • Receive Transition of Care

  • Send of Transition of Care

How Do We Sign up for MACRA?

For MIPS, you do not need to sign up. Simply report your data during the reporting period. For Advanced APM, you report through that group. If you choose not to report, you will receive a -4% adjustment.

How Do You Report Our Data for MIPS?

MIPs data can be reported via the same methods as the previous meaningful use programs. This includes claims, registry, QRDC, and EHR incentive payment attestation site.

Do I Participate in Macra If I Am Doing Medicaid Meaningful Use?

As a provider you would have to accept Medicare Part B with more than 100 Medicare patients, or bill more than $30,000 in Medicare Part B claims.

What Is the Timeline of the QPP?

CMS was required to initiate the measurements for MIPS and Advanced APMs from Jan 1st, 2017. The provider performance, as measured in 2017, will impact the reimbursements they receive in 2019.