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.
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
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:
Clinical nurse specialist
Certified registered nurse anesthetist
Clinicians who bill Medicare Part B will be impacted by the Quality Payment Program.
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.
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
Quality, Resource Use, Clinical practice improvement activities, advancing care information.
To participate in MACRA, you would need a certified EHR. For 2017, the EHR has to be 2014, or 2015 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.
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.
MIPS features 217 quality measures for clinicians to choose from.
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.
There are 93 different improvement activities that are broken into 8 domains. The domains are:
Patient Safety & Practice Assessment
Behavior and Mental Health
Achieving Health Equity
Expanded Practice Access
Emergency Response & Preparedness
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.
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:
Security Risk Assessment
Receive Transition of Care
Send of Transition of Care
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.
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.
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.
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.