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Submit by March 31,
2018
Feedback 2018
AdjustmentJanuary 1,
2019
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
Quality Payment Program
TimelinePerformance Year
2017
Performance Period
JANUARY
1December
312017
The first performance period opens on January 1, 2017 and closes December 31, 2017
Support for small and independent practices
New opportunities for Advanced Alternative
Payment Models
A flexible, pick-your-own-pace approach
One unified program supporting
Clinician-Driven Quality Improvement
Changes in the Final Rule
• Less than or equal to $30,000 in Medicare Part B allowed charges • Less than or equal to 100
Medicare patients
Small Practice Exclusion
Small, independent practices will be excluded from new requirements if volume is:
What Is An Advanced Alternative Payment Model?
Under the new law, Advanced APMs are the CMS Innovation Center models, Shared Savings Program tracks, or demonstrations where clinicians accept both risk and reward for providing coordinated, high quality, and efficient care. These models must also meet criteria for payment based on quality measurement and for the use of EHRs.
APM Path
You earn a
5% incentive payment in 2019*
* If you receive 25% of Medicare payments * If you see 20% of your Medicare patients through an Advanced APM in 2017
What is MIPS?
• MACRA combines the existing Medicare Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs into MIPS, starting with the 2017 performance year. • MIPS payment adjustments are applied to Medicare
Part B payments two years after the performance year, with 2019 being the payment adjustment year for the 2017 performance year.• MIPS defines four categories of eligible Provider
performance, contributing to a MIPS composite performance score (CPS) of up to 100 points
Who is in the Quality Payment Program?
You are a: PhysicianPhysician AssistantNurse PractionerClinical Nurse SpecialistCertified Registered Nurse Anesthetist
you bill Medicare more than $30,000 a year and
provide care for more than 100 Medicare patients a year
If 2017 is your first year participating in Medicare, then you are not in the MIPS track of the Quality Payment Program.
Qualifying APM participant
Partial qualifying APM participant
Doesn’t meet the low volume threshold
Who Is Exempt?
Pick Your Pace
1Don’t Participate
-4% payment
adjustment 2Submit
Something
0% payment
adjustment
3Submit a partial year
+% payment
adjustment
4Submit a full year
+% payment
adjustment
You Have Choices
You can choose how you want to participate based on your: Practice size
Specialty Location
Patient population
** Potentially up to 3 times these rates plus up to a 10% exceptional performance bonus **
Financial Impact Over Time
Performance Year 2017
Medicare Part B
Payment Adjustment Year 2019
+4% Incentive and -4% Penalty
Performance Year 2018
Medicare Part B
Payment Adjustment Year 2020
+5% Incentive and -5% Penalty
Performance Year 2019
Medicare Part B
Payment Adjustment Year 2021
+7% Incentive and -7% Penalty
Performance Year 2020
Medicare Part B
Payment Adjustment Year 2022
+9% Incentive and -9% Penalty
• CMS will set a threshold performance score each year based on all eligible provider scores from a prior period. • Scores exactly equal to the performance threshold
= zero payment adjustment • Scores progressively above the performance
threshold = progressively increasing incentives • Scores progressively below the performance
threshold = progressively increasing penalties
Every Point Counts
How is it scored?
4 performance
categories
Cost in 2017
0 points
Advancing Care
Information (formerly
Meaningful Use) 25 points
Clinical Practice
Improvement Activities 15 points
Quality (PQRS/VBM) 60 points
Quality Points ExampleIf a PQRS measure has a 62% measure rate better than 60% of peers reflected in the benchmark, then that measure would earn 7 out of 10 possible points.
Quality Points Example
CMS Quality Payment Program Website
What can I do now to prepare for January 2017?
• Educate your organization as soon as possible• Estimate your MIPS score using your current MU,
PQRS and VBM scores• Optimize MU & PQRS/VBM Quality to maximize the
MIPS score• Evaluate staff, resources and organizational structure• Identify 2016 deadlines impacting 2017 MIPS, such
as the Medicare Shared Savings Program Track 2/3 ACO or NCQA PCMH application deadlines to gain MIPS exemptions or points
CareOptimize Analytics
Mining The Ability to Impact scale
brings in clinical, social, and administrative factors to
determine which patients are worth addressing
Visualizing Package of preset graphs,
heat maps, plots, and diagrams eases consumption
of data
Reporting Two Hour Guarantee -
Sometimes you need an answer immediately
Actions Key indicators automatically
create actions
Data Submission Quality programs require
data submission - HEDIS • GPRO • Other
quality measures
CareOptimize Population Management Module
CareOptimize Care Management Module
One Easy-to-Review ScreenThe CareOptimize Care Management module collects all
relevant clinical information from disparate sources feeding the enterprise data warehouse and displays it on a single screen.
• Automatically create evidence-based care plans specific to a patient’s • diseases and social impacts in seconds using the integration with
M*Modal.• Review the evidenced-based literature included with the protocol, or
simply override it on a per patient, per provider, or per organization basis.
• Add your own protocols for your specific patient population.
Routine contact with a Care Manager can be the difference between a stable patient or an expensive hospital stay. Medical assistants, health coaches, nurses, and physicians can proactively reach out to these patients and stop preventable expenses before they occur.
Identify. Assign. Engage. Measure.
After your high-risk, high-cost, high-ability-to-impact patients have been identified, the cost improvements can
have a dramatic increase on your bottom line.
CareOptimize Coding Module
Make sure you are correctly reimbursed for the additional costs unhealthier patients incur
• More precise diagnosis data• Supported clinical documentation in case of an
audit • Greater efficiency, accuracy, and workflow
management• Correct reimbursement
• Discrete data from the EHR • Claims data from payer
feeds • Scanned specialist notes • (neatly) Hand written
notes
Coding Accuracy ModuleMore than 1,000,000 disease concepts
developed over the past 15 years
Opportunities are identified overnight and available directly to physician at point of care Selected codes are automatically added to the encounter’s assessments within the EHR workflow Opportunities are reviewed and validated by coders before being sent on to the physician Rejected opportunities are continually reviewed
Coding Opportunities
The CareOptimize Peer Benchmarking Module
Automates registration for MIPS, MACRA, MU, PQRS, and VBPM
Displays how peer organizations are scoring on measures, including which are topped out
Recommends the best ways to maximize scores against your peers
Automates the attestation process to CMS or Medicaid
Gives real-time progress on CMS
How Can CareOptimize Help?
• CareOptimize offers a State of the Practice Evaluation. This is a free evaluation that looks to see if your practice is running efficiently, checks to see if you are maximizing your reimbursements, and reviews the system to see if you are keeping up with Meaningful Use and all of the updated regulations. This evaluation also answers the question Are you ready for MIPS?
• A CareOptimize project specialist will run your report, review it and go over it in detail with you to discover what you can be doing to make your practice even better.
State of the Practice Report
• Top 20 Payers• Denial Rate• A/R Aging• Bill Lag Time• Charge Entry Lag Time• Unapplied Credits• Active Contracts• BBP Jobs List• Average Appointment per Day
by Provider
The State of the Practice Report captures information in these areas
• First Third Appointment by Resource
• Meaningful Use• CQM/PQRS by Provider• CCM Coding• All Users with Greater than 20 Tasks• All Users with Tasks Over 7 Days• All Templates in Use During the Last
2 Months• All KBM Templates in Use During
the Last 2 Months• Referrals Open
Contact Us
Please contact us to sign up for this free report today!! [email protected]
Jonathan Shivers:[email protected]
Please follow http://www.ehrutilities.com/ to see additional utilities provided by CareOptimize.
CMS Additional Resources
• CMS offers additional resources to help guide you through this final rule. https://qpp.cms.gov/education• Quality Payment Program Fact Sheet:
https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf• Where to find Help:
https://qpp.cms.gov/docs/QPP_Where_to_Go_for_Help.pdf• Comprehensive list of APMs:
https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf
CMS Additional Resources (Continued)
• CMS also offers Videos as well as Webinars. • The Quality Payment Program Service Center is also
available to help. 1-866-288-8292 Monday-Friday 8:00am-8:00pm EST Questions can also be sent via email to [email protected] The new website CMS has created for this program can be accessed at https://qpp.cms.gov/
