Macra and Hospitalists: Get Your Questions Answered

MACRA and Hospitalists: Get Your Questions Answered

Presented By: Liz Morgan – Senior Solutions Engineer, Iatric Systems Cindy Paul – Senior Project Manager, Professional Service, Iatric Systems Technical Assistance: Amanda.Howell@iatric.com This teleconference will be muted while we wait for all attendees to join. Thank you for your patience.

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Presented By: Liz Morgan – Senior Solutions Engineer, Iatric Systems Cindy Paul – Senior Project Manager, Professional Service, Iatric Systems Date: June 6, 2017

MACRA and Hospitalists: Get Your Questions Answered

Agenda

•  MACRA/MIPS/QPP - Defined •  Eligibility – Who needs to Participate •  Timing – Pick Your Pace •  Program Components MIPS •  CMS Notifications •  QPP and Groups •  CMS Deadline •  How to Get Help •  Q&A

Poll question

Do you believe your hospitalists bill $30,000 AND see more than 100 patients for Medicare Part B or Observation? a) Yes b) No c)  Don’t Know

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

•  Passed by congress April 14,2015

•  Removes Sustainable Growth Rate Methodology – SGR

•  Revise the update in rates

•  Establishes Quality Payment Program (QPP)

•  Final Rule issued October 14, 2016

Eligible Clinicians (EC)

Hospitalists Anesthesiologist Radiologists

Pathologists Emergency Department Physician

Clinicians who have billed more than $30,000 in Medicare Part B allowable charges and have more

than 100 Part B-enrolled Medicare beneficiaries

Pick Your Pace

Payment Adjustment

Four Categories

2017

2017

2017

2018

Categories and Percentage

Quality

60% Need to report 6

Improvement Activities

15% Need to report 4

Advancing Care Information

25%

Cost

2018

85% 15%

CMS Notification •  Letters went out to each Eligible Clinician •  Mailed to TIN •  Late April or Early May •  Designated if they were eligible

Poll question

Have you received a letter from CMS stating that you are required to submit for MIPS? a) Yes b) No c)  Don’t Know

QPP and Groups

Reporting as Individual

•  Individual National Provider Identifier •  Tied to single Tax Identification Number

(TIN) •  Individual data for each MIPS Category •  Payment adjustment based on YOUR

performance

Reporting as a Group

Group Defined: Set of eligible clinicians, identified by their National Provider Identifier (NPI) sharing a

common Tax Identification Number (TIN), no matter the specialty or practice site.

Group

•  One TIN •  Regardless of specialty or practice site •  Aggregated group level data sent for each

MIPS Category •  In-Hospital physicians in group – no need to

report on Advancing Care Information

Digesting CMS Information The hospital-based determination is done at the

individual national provider identifier (NPI) level. If an eligible clinician is determined to be hospital-based, that

status will apply to all NPI/ tax identification number (TIN) combinations for the clinician. If an individual

eligible clinician is hospital-based, we will automatically reweight the Advancing Care Information (ACI)

performance category. If the eligible clinician is part of a group, the group has the option to include or exclude

ACI data for the hospital-based clinician(s). If the entire group is hospital-based, the group's ACI category will be reweighted if the group does not submit any ACI data. The group, despite being entirely hospital-based, would have the option to include, or not include their data in

the group data that is submitted to CMS, but their payment will be adjusted based on the group's MIPS final

score.

If an eligible clinician is determined to be hospital-based, that status will apply to all NPI/ tax identification number

(TIN) combinations for the clinician. If an individual eligible clinician is hospital-based, we will automatically

reweight the Advancing Care Information (ACI) performance category. If the eligible clinician is part of a

group, the group has the option to include or exclude ACI data for the hospital-based clinician(s). If the entire group is hospital-based, the group's ACI category will be reweighted if the group does not submit any ACI data.

The group, despite being entirely hospital-based, would have the option to include, or not include their data in the

group data that is submitted to CMS, but their payment will be adjusted based on

the group's MIPS final score.

Groups, Quality, and the Physician Compare Conundrum

Groups and Physician Compare

•  PQRS = MIPS Quality •  Selected Measures apply to all physicians •  Tax Identification Number •  Data Aggregation

Questions for Your Consideration

•  Do you have one TIN? •  Does this structure have the ability to satisfy

all your physician types? •  If not, how could your hospital benefit? •  Does it really matter if a physician has no

data on Physician Compare?

Things to Think About

•  This is a QUALITY program – how will the group fare?

•  Hospital Contract? •  What is your plan? October 2nd is the last day to

get 90 days of information

Deadline:

For groups to use the CMS Web Interface, you

must register by June 30, 2017

Get Help Defining Your Plan q  Identify which providers or groups are MIPS eligible

within your organization

q  Assist with Pick Your Pace

q  Assist with identifying Quality Measures

q  Assist with identifying Improvement Activities

q  Gap Analysis q  Action Plan

What Questions Do You Have?

We Can Help!

Liz Morgan Senior Solutions Engineer – Iatric Systems

Phone: (978) 674-8317 E-mail: Liz.Morgan@iatric.com

Connect with me on LinkedIn: Liz Morgan

Cindy Paul Senior Project Manager, Iatric Systems

Phone: (978) 674-5927 Email: Cindy.Paul@iatric.com

Connect with me on LinkedIn: Cindy Paul

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