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Succeeding in MACRA and MIPS
Samuel Peirce, User Success Specialist
samuel.peirce@elationhealth.com
1/ What MACRA means for your practice (Slides 3-10)
2/ MIPS Participation Checklist (Slides 11-13)
3/ MIPS Performance Cat...
What MACRA means for your practice
What is MACRA?
● Medicare Access & CHIP
Reauthorization Act.
● Repeals the Sustainable Growth Rate.
● Replaces the Physici...
Why you should care about MACRA
1/ If you see Medicare patients, there is significant practice revenue at stake.
Medicare ...
3/ The MACRA Final Rule was released on October 14th 2016.
Providers have been given less than 3 months to fully prepare f...
MACRA creates 2 programs for providing quality-based payments:
How Providers get Paid under MACRA
MIPS (Default)
Merit-Bas...
Merit-Based Incentive Payment System (MIPS)
There are currently multiple individual quality and value programs for Medicar...
Benefits of Participating in MIPS
● MIPS is a zero-sum game
● Adjustments begin at 4%
● $500 million set aside for the fir...
Advanced APMs have higher financial
incentives, but also require increased
practice transformation and reporting.
Advanced...
MIPS Participation
✓ Am I Eligible?
✓ Am I using a certified EHR technology?
✓ Do I know what the performance categories are?
✓ Do I know MIP...
MIPS Participation Eligibility
Eligible Provider: Physician, PA, NP, CNS, and CRNA
MIPS Exclusions
1/ Less than 100 Medica...
MIPS Performance Categories
MIPS Performance Categories
Replaces PQRS Replaces VBMNew CategoryReplaces MU
MIPS Performance Categories:
2017 Weights
Quality (60%)
Improvement Activities (15%)
Advancing Care Information (25%)
MIPS Performance Categories:
Quality
Report on 6 quality measures, including at
least one outcome measure
Example: CMS165v...
MIPS Performance Categories:
Advancing Care Information
Report on the 5 required measures:
1/ Security Risk Analysis
2/ e-...
MIPS Performance Categories:
Clinical Improvement Activities
Report on 4 clinical improvement
activities
Example: IA_BMH_4...
MIPS Reporting in 2017
MIPS Reporting in 2017: Pick Your Pace
MIPS
Advanced APMs
MIPS Reporting in 2017: Timeline
How Elation enables practices to achieve
success with MIPS
Elation continues to be committed to supporting phenomenal
care, and is committed to the Health IT requirements needed
to ...
Elation Supports MIPS: Quality
Elation’s built-in quality measures dashboard makes it easy to track your
progress on quali...
Elation Supports MIPS: Quality
Elation provides clinical decision support at the point of care.
Elation Supports MIPS: Advancing Care Info
Elation’s built-in MU dashboard makes it easy to track your progress
Elation Supports MIPS: Advancing Care Info
Elation provides MU reminders at the point of care.
Elation Supports MIPS: Improvement Activities
Track diagnoses such as depression in the patient’s Problem List and Visit
N...
Next Steps
In Summary
1/ Continue providing phenomenal care to your patients
2/ Elation will continue supporting your care to ensure ...
Questions?
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Succeeding in MACRA and MIPS

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Learn about everything you need to know about reporting and reimbursement transformation in 2017.

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Succeeding in MACRA and MIPS

  1. 1. Succeeding in MACRA and MIPS Samuel Peirce, User Success Specialist samuel.peirce@elationhealth.com
  2. 2. 1/ What MACRA means for your practice (Slides 3-10) 2/ MIPS Participation Checklist (Slides 11-13) 3/ MIPS Performance Categories (Slides 14-19) 4/ Reporting MIPS in 2017 (Slides 20-22) 5/ How Elation supports practices on MIPS (Slides 23-29) 6/ Next Steps & Q&A (Slides 30-31) Agenda
  3. 3. What MACRA means for your practice
  4. 4. What is MACRA? ● Medicare Access & CHIP Reauthorization Act. ● Repeals the Sustainable Growth Rate. ● Replaces the Physician Fee Schedule. ● Creates the Quality Payment Program (QPP).
  5. 5. Why you should care about MACRA 1/ If you see Medicare patients, there is significant practice revenue at stake. Medicare is fundamentally changing how they reimburse providers, and will begin paying for quality, not volume. 2/ The burden is on the provider to report on patient outcomes in order to capture the maximum reimbursement. EHR vendors like Elation can help you transform your practice to consistently measure outcomes for you to report on.
  6. 6. 3/ The MACRA Final Rule was released on October 14th 2016. Providers have been given less than 3 months to fully prepare for MACRA, making diligence and quality information paramount to success. 4/ MACRA legislation will go into effect January 2017. Reporting for MACRA programs will begin on January 1, 2017. Reimbursement and adjustments timing will vary depending on the MACRA program. Why you should care about MACRA
  7. 7. MACRA creates 2 programs for providing quality-based payments: How Providers get Paid under MACRA MIPS (Default) Merit-Based Incentive Payment System Advanced APM Advanced Alternative Payment Model
  8. 8. Merit-Based Incentive Payment System (MIPS) There are currently multiple individual quality and value programs for Medicare physicians and practitioners. MACRA streamlines those programs into MIPS: MIPS Composite Performance Score
  9. 9. Benefits of Participating in MIPS ● MIPS is a zero-sum game ● Adjustments begin at 4% ● $500 million set aside for the first 6 years for top performers ● MIPS provides a single reporting solution, replacing PQRS, MU, and VBM. ● MIPS continues the industry shift towards value
  10. 10. Advanced APMs have higher financial incentives, but also require increased practice transformation and reporting. Advanced Alternative Payment Models (APMs) Approved Advanced APM List: CPC+ Comprehensive ESRD Care Model MSSP ACOs - Track 2 & Track 3 Next Generation ACO ModelOncology Care Model
  11. 11. MIPS Participation
  12. 12. ✓ Am I Eligible? ✓ Am I using a certified EHR technology? ✓ Do I know what the performance categories are? ✓ Do I know MIPS timeline and deadlines in 2017? MIPS Participation Checklist
  13. 13. MIPS Participation Eligibility Eligible Provider: Physician, PA, NP, CNS, and CRNA MIPS Exclusions 1/ Less than 100 Medicare fee-for-service patients and $30,000 in Medicare charges 2/ Participating in an Advanced APM 3/ First-year Medicare providers
  14. 14. MIPS Performance Categories
  15. 15. MIPS Performance Categories Replaces PQRS Replaces VBMNew CategoryReplaces MU
  16. 16. MIPS Performance Categories: 2017 Weights Quality (60%) Improvement Activities (15%) Advancing Care Information (25%)
  17. 17. MIPS Performance Categories: Quality Report on 6 quality measures, including at least one outcome measure Example: CMS165v5: Controlling High Blood Pressure Percentage of patients 18-85 years of age who had a diagnosis of hypertension and whose blood pressure was adequately controlled (<140/90 mmHg) during the measurement period Quality (60%)
  18. 18. MIPS Performance Categories: Advancing Care Information Report on the 5 required measures: 1/ Security Risk Analysis 2/ e-Prescribing 3/ Provide Patient Access 4/ Send Summary of Care 5/ Request and Accept Summary of Care Submit up to 9 measures for additional credit Advancing Care Information (25%)
  19. 19. MIPS Performance Categories: Clinical Improvement Activities Report on 4 clinical improvement activities Example: IA_BMH_4: Depression screening Depression screening and follow-up plan: Regular engagement of MIPS eligible clinicians or groups in integrated prevention and treatment interventions, including depression screening and follow-up plan Improvement Activities (15%)
  20. 20. MIPS Reporting in 2017
  21. 21. MIPS Reporting in 2017: Pick Your Pace MIPS Advanced APMs
  22. 22. MIPS Reporting in 2017: Timeline
  23. 23. How Elation enables practices to achieve success with MIPS
  24. 24. Elation continues to be committed to supporting phenomenal care, and is committed to the Health IT requirements needed to support practices on MIPS.
  25. 25. Elation Supports MIPS: Quality Elation’s built-in quality measures dashboard makes it easy to track your progress on quality measures
  26. 26. Elation Supports MIPS: Quality Elation provides clinical decision support at the point of care.
  27. 27. Elation Supports MIPS: Advancing Care Info Elation’s built-in MU dashboard makes it easy to track your progress
  28. 28. Elation Supports MIPS: Advancing Care Info Elation provides MU reminders at the point of care.
  29. 29. Elation Supports MIPS: Improvement Activities Track diagnoses such as depression in the patient’s Problem List and Visit Note. (IA_BMH_4: Depression Screening)
  30. 30. Next Steps
  31. 31. In Summary 1/ Continue providing phenomenal care to your patients 2/ Elation will continue supporting your care to ensure your success on MIPS ● Elation’s Blog: Focus on MACRA and upcoming CMS releases ● Elation's MACRA Help Center 3/ Practices can start familiarizing themselves with the program ● Continue attending Elation’s webinars ● Elation MIPS Guide ● Quality Payment Program Website
  32. 32. Questions?

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