Posts Tagged ‘Merit-Based Incentive Payment System’

Infographic: 2019 Merit-based Incentive Payment System Adjustment for 2017 Performance Year

October 15th, 2018 by Melanie Matthews

Clinicians will receive a positive, neutral, or negative payment adjustment factor based on their 2017 Merit-based Incentive Payment System (MIPS) final score, according to a new infographic by the Centers for Medicare and Medicaid Services.

The infographic examines the MIPS final score and payment adjustment factors.

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS SuccessA laser focus on population health interventions and processes can generate immediate revenue streams for fledgling accountable care organizations that support the hard work of creating a sustainable ACO business model. This population health priority has proven a lucrative strategy for Caravan Health, whose 23 ACO clients saved more than $26 million across approximately 250,000 covered lives in 2016 under the Medicare Shared Savings Program (MSSP).

Profiting from Population Health Revenue in an ACO: Framework for Medicare Shared Savings and MIPS Success examines Caravan Health’s population health-focused approach for ACOs and its potential for positioning ACOs for success under MSSP and MACRA’s Merit-based Incentive Payment System (MIPS).

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In Successful ACOs, Population Health Focus Paves Way for Shared Savings Payouts

January 25th, 2018 by Patricia Donovan

Physician practices toiling in fledgling ACOs and obsessing over shared savings that have not yet materialized, take heart: population health offers multiple revenue streams for accountable care organizations waiting for the “gravy” of accountable care.

“Gravy” is the way Tim Gronniger, senior vice president of development and strategy for Caravan Health, refers to ACO shared savings payouts, which he says can take considerable time to accrue.

“It is literally two years from the time you jump into an ACO before you have even the chance of a shared savings payout,” Gronniger told participants in Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast now available for replay.

Obsessing over shared savings is one of the biggest mistakes hospitals in ACOs can make, he added.

This delay is one reason Caravan Health urges its ACOs to adopt a population health focus, whether pursuing the Centers for Medicare and Medicaid Services (CMS) Quality Payment Program (QPP) Merit-based Incentive Payment System (MIPS) or the Medicare Shared Savings Program (MSSP).

Gronniger’s advice is predicated on his organization’s experience of mentoring 38 ACOs. In 2016, Caravan Health’s ACOs saved more than $26 million in the MSSP program and achieved higher than average quality scores and quality reporting scores, according to recently released CMS data.

Walking attendees through a MACRA primer, Gronniger underscored the challenges of the MIPS program, one of three tracks offered under the Quality Payment Program. “Barring a really exceptional performance on MIPS, you can’t even break even over the next few years on physician compensation,” he said.

In the meantime, ACOs should utilize recently rolled out Medicare billing codes, from the annual wellness visit (AWV) to advanced care planning, to generate wellness revenue. With proper planning, reengineering of staffing and clinical work flows, a practice could generate anywhere from five hundred to one thousand dollars annually per eligible Medicare patient, Gronniger estimates—monies that offset the cost of constructing a sustainable ACO business model.

To back up this population health rationale, Gronniger pointed to data from an ACO client demonstrating the impact of a cohesive PHM approach, including the use of trained population health nurses, on completion rates for preventive screenings. For less top-of-mind screenings like falls assessment and smoking cessation, completion rates rose from negligible to near-universal levels, he said.

“These are recommended sets of screens that are required by CMS, but that also help ACOs with quality measures,” he added.

Gronniger also shared examples of dashboards, scorecards and roadmaps Caravan Health employs to help keep client ACOs on track. An ACO success strategy involves “a lot of dashboarding, checking in, and discussion of problems and barriers, discussion of solutions, and monthly and quarterly measurement and reporting back,” he said.

Beyond coveted shared savings, ACO participation offers significant non-financial benefits, including quality improvements under both MSSP and MIPS standards, availability of ACO-specific waivers, and access to proprietary performance data.

Overall, ACO participation can make providers more attractive both to commercial contractors and to potential patients perusing Physician Compare ratings in greater numbers.

Gronniger ended by weighing in on the recent recommendation by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the MIPS program.

Assessing MIPS’ Fate: “MedPAC Vote Would Not Affect 2018 Under Any Scenario”

January 18th, 2018 by Patricia Donovan

Tim Gronniger

Tim Gronniger, Senior VP of Development and Strategy, Caravan Health

Amidst healthcare provider outcry over last week’s vote by the Medicare Payment Advisory Commission (MedPAC) to repeal and replace the Merit-based Incentive Payment System (MIPS), an industry thought leader sought to remind physician groups that no change to MIPS is imminent.

“MedPAC is an advisory body, not a legislative one,” said Tim Gronniger, senior vice president of development and strategy for Caravan Health, a provider solutions for healthcare organizations interested in value-based payment models, including accountable care organizations (ACOs).

“Congress would need to adopt MedPAC’s recommendations in order for the changes to go into effect. It is reasonable to expect MIPS to evolve over time, but that evolution will be gradual. [MedPAC’s vote on MIPS] would not affect 2018 under any scenario.”

Gronniger made his comments during Generating Population Health Revenue: ACO Best Practices for Medicare Shared Savings and MIPS Success, a January 2018 webcast sponsored by the Healthcare Intelligence Network and now available for rebroadcast.

Earlier this month, MedPAC voted 14-2 to scrap the MIPS program, describing it in a presentation to members as “burdensome and complex.” According to the advisory commission, “MIPS will not succeed in helping beneficiaries choose clinicians, helping clinicians change practice patterns to improve value, or helping the Medicare program to reward clinicians based on value.”

MedPAC is expected to pass this recommendation along to Congress in coming months, along with a proposed alternative. In MIPS’s place, MedPAC is suggesting a voluntary value program (VVP) in which “group performance will be assessed using uniform population-based measures in the categories of clinical quality, patient experience, and value.”

MGMA’s Anders Gilberg reacts to the MedPAC ruling.

Among the provider groups reacting to MedPAC’s actions was the Medical Group Management Association (MGMA). In a Twitter post, Anders Gilberg, MGMA’s senior vice president for government affairs, called the VVP alternative “a poor replacement,” claiming it “would conscript physician groups into virtual groups and grade them on broad claims-based measures.”

The day prior to the January 11 vote, MGMA had reached out in a letter to Seema Verma, administrator for the Centers for Medicare & Medicaid Services (CMS), requesting CMS to immediately release 2018 Merit-based Incentive Payment System (MIPS) eligibility information, which it called “vital to the complex clinical and administrative coordination necessary to participate in MIPS.”

4 Ways CMS 2018 Quality Payment Program Supports ‘Patients Over Paperwork’ Pledge

November 6th, 2017 by Patricia Donovan

“Patients Over Paperwork” is committed to removing regulatory obstacles that get in the way of providers spending time with patients.

Year 2 of the CMS Quality Payment Program promises continued flexibility and reduced provider burden, according to the program’s final rule with comment issued by the Centers for Medicare and Medicaid Services (CMS) last week.

The Quality Payment Program (QPP), established by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), is a quality payment incentive program for physicians and other eligible clinicians that rewards value and outcomes in one of two ways: through the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

A QPP Year 2 fact sheet issued by CMS highlights 2018 changes for providers under the QPP’s MIPS and APM tracks. The Year 2 fact sheet noted that stakeholder feedback helped to shape policies for QPP Year 2, and that  “CMS is continuing many of its transition year policies while introducing modest changes.”

In keeping with the federal payor’s recently launched “Patients Over Paperwork” initiative, QPP Year 2 reflects the following changes:

    • More options for small practices (groups of 15 or fewer clinicians). Options include exclusions for individual MIPS-eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries, opportunities to earn additional points, and the choice to form or join a virtual group.
    • Addresses extreme and uncontrollable circumstances, such as hurricanes and other natural disasters, for both the 2017 transition year and the 2018 MIPS performance period, by offering hardship exception applications and limited exemptions.
    • Includes virtual groups as another participation option for Year 2. A virtual group is a combination of two more taxpayer identification numbers (TINs) made up of solo practitioners and groups of 10 or fewer eligible clinicians who come together ‘virtually’ (no matter specialty or location) to participate in MIPS for a performance period of a year. A CMS Virtual Groups Toolkit provides more information, including the election process to become a virtual group.
    • Makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year. Updated QPP policies for 2018 further encourage and reward participation in APMs in Medicare.
  • CMS describes its Patients Over Paperwork effort as “a cross-cutting, collaborative process that evaluates and streamlines regulations with a goal to reduce unnecessary burden, increase efficiencies and improve the beneficiary experience. This effort emphasizes a commitment to removing regulatory obstacles that get in the way of providers spending time with patients.”

    CMS Quality Payment Program: Clinicians Should Expect MIPS Participation Status Letter This Month

    May 4th, 2017 by Melanie Matthews

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    CMS has specified two key criteria for MIPS participation.

    The Center for Medicare and Medicaid Services (CMS) is reviewing claims and letting practices know which clinicians need to take part in the Merit-based Incentive Payment System (MIPS), according to information on MLNConnects, the CMS Medical Learning Network.

    MIPS is an important part of the new Quality Payment Program (QPP). In late April through May, clinicians will get a letter from their Medicare administrative contractor that processes Medicare Part B claims, providing the participation status of each MIPS clinician associated with their Taxpayer Identification Number (TIN).

    Clinicians should participate in MIPS in the 2017 transition year if they meet the following conditions:

    • Bill more than $30,000 in Medicare Part B allowed charges a year; and
    • Provide care for more than 100 Part B-enrolled Medicare beneficiaries a year.

    The QPP intends to shift reimbursement from the volume of services provided toward a payment system that rewards clinicians for their overall work in delivering the best care for patients. It replaces the Sustainable Growth Rate (SGR) formula and streamlines the “Legacy Programs:” Physician Quality Reporting System, the Value-based Payment Modifier, and the Medicare Electronic Health Records Incentive Program.

    During this first year of the QPP program, CMS said it is committed to working with clinicians to streamline the process as much as possible. The federal payor stated that its goal is to further reduce burdensome requirements so that providers can deliver the best possible care to patients.

    Infographic: Navigating the Merit-Based Incentive Payment System

    February 17th, 2017 by Melanie Matthews

    The goal of the Centers for Medicare and Medicaid Services’ new quality program, the Merit-Based Incentive Payment System (MIPS), is to streamline quality reporting to CMS and improve care, according to a new infographic by athenaInsight, Inc.

    The infographic examines how MIPS will impact an average clinician this year…and in 2019 when the 2017 reporting will impact a clinician’s reimbursement rates.

    Infographic: EHR + CRM = Superior Patient Engagement

    Under CMS’s “Pick Your Pace” choices for Year 1 Quality Payment Program participation, physician practices may opt for the minimum activity necessary to avoid a payment penalty in 2019: simply submitting some data in 2017.

    However, instead of delaying MACRA participation to the later part of this year, physicians should prepare and better position themselves today for MIPS success by analyzing their existing CMS data on their practices’ performance and laying a path toward performance improvement.

    Physician MACRA-Readiness: Mining QRUR and Other CMS Data to Maximize MIPS Performance describes the wealth of data analytics available from the CMS Enterprise Portal–Quality Resource Use Reports (QRURs) and other reports providing a window into practice performance under the Merit-Based Incentive Payment System (MIPS). MIPS is one of two MACRA reimbursement paths and the one where most physician practices are expected to align.

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    At MACRA Launch, Think Like a MIPS Top Performer

    January 9th, 2017 by Patricia Donovan
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    A focus on quality activities like influenza vaccines is a good starting point for MIPS performance improvement.

    With the opening of the first Quality Payment Program performance period on January 1, 2017, many eligible healthcare providers have picked their MACRA participation pace and begun to collect performance data. In certain cases, Merit-based Incentive Payment System (MIPS) top performers and MIPS exceptional performers potentially could fare better than Advanced Alternative Payment Model (APM) practices. Here, Barry Allison, chief information officer, the Center for Primary Care, describes some ways clinicians can aspire toward MIPS top performer or exceptional performer status.

    According to the Centers for Medicare and Medicaid Services (CMS), a MIPS top performer must be one standard deviation point above the mean, as far as the total cost of care for the patient as well as for the quality metrics reported to CMS. This illustrates why it is critical to look at your organization’s Quality and Resource Use Report (QRUR) data. From looking at our own QRUR data internally, we want to be in the 90th percentile or higher for things like annual flu shots, influenza vaccines, Pneumovax® vaccinations, or Prevnar® vaccinations in conjunction with the Pneumovax 23.

    These are very key points. For most EHRs and registries, if you look at quality, that 60 percent that CMS will review in MACRA’s first year, those are the activities where you should aim to report at the high end. I would recommend anywhere from 88 percent and upwards, but my minimum would be reporting on 90 percent of areas where you can use technology to deploy a short message service (SMS) outreach campaign for influenza vaccines or similar tasks.

    You want to make sure that in the areas considered low hanging fruit, that you’re either rendering those services, or if you don’t render those types of services, you direct the patient toward a Medicare provider or provider that does render those services and from whom Medicare receives that information.

    Let’s take flu shots, for example. Even though your particular practice may not render that service, you should refer your patients somewhere that does administer the shots. You want to refer that patient somewhere where you know that claim will be filed to Medicare, because through their attribution methodology, you’re still that patient’s primary care provider. You still get credit right now for that quality element, even though you may not have administered the shot.

    Source: Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA

    http://hin.3dcartstores.com/Home-Visits-for-Clinically-Complex-Patients-Targeting-Transitional-Care-for-Maximum-Outcomes-and-ROI_p_5180.html

    Physician Chronic Care Management Reimbursement: Roadmap to MIPS Success Under MACRA describes how early adoption of Medicare’s CCM Reimbursement program enhanced the Center’s MACRA-readiness, laying the foundation for success under the Merit-based Incentive Payment System (MIPS) path.

    MACRAeconomics: Chronic Care Management Is the Future of Medicare Reimbursement

    November 3rd, 2016 by Patricia Donovan

    The newly finalized 2017 Physician Fee Schedule expands Chronic Care Management codes to complex patients with multiple chronic illnesses.

    Managing a Medicare population, particularly when the majority has two or more chronic illnesses, can be daunting. But in the current realm of healthcare reimbursement, the care of these beneficiaries is rife with opportunity.

    “Depending on the manner in which you’re managing your Medicare Part B demographic, you have an opportunity to generate from 100 to 120 percent of the Medicare fee schedule under MACRA,” noted Barry Allison, chief information officer, the Center for Primary Care, during Physician Chronic Care Management Reimbursement: Setting MACRA’s MIPS Path for 2017.

    During this October 2016 webinar now available for replay, Allison described how early adoption of Medicare’s Chronic Care Management (CCM) Reimbursement program enhanced the Center’s MACRA-readiness under the Merit-based Incentive Payment System (MIPS) path. By identifying the more than three-quarters of its 24,000 active Medicare beneficiaries that met CMS’s CCM requirements, the Center had a ready pool of patients on which to overlay CMS’s care coordination best practices and begin earning crucial CCM revenue.

    “CMS recognizes that care management is a critical component of primary care. It contributes to better health and care for individuals, as well as reduced spending,” said Allison, who estimates his 40-provider organization is the largest chronic care management initiative in the Southeast.

    Using the value-based modifier data available within CMS’s Quality Use and Resource Report (QRUR), The Center for Primary Care further identified its percentage of high-risk Medicare patients for more focused care management.

    Accessing and reviewing QRUR reports, available from the CMS Enterprise Identity Management (EIDM) desk, is an essential prerequisite to MACRA participation, advised Allison, who also detailed the type of reports and data available from the QRUR. “Procure that data as soon as possible, because you can learn a lot about what CMS will be looking for in the future, and how the value-based modifier will actually become a part of that MACRA multi-pronged approach.”

    While his organization’s CCM program utilized ENLI software to identify ‘hot-spotter’ data elements such as unfilled prescriptions or ER visits for specific conditions, physician practices that lack this technology still have many tools at their disposal—even appointment scheduling software—to identify high-risk patients.

    “Open up consistent lines of dialogue and engage your providers. Sit down with them and say, ‘You know your patients better than anyone else. Tell us who to reach out to.'” With or without CCM software, practices should “document, document, document” the amount of time devoted to CCM, as well as how that time benefited patients.

    Long-term planning rather than a reactive view will better position physician practices for success under MACRA’s Quality Payment Program, Allison concluded. The Center is already estimating how it will fare under Medicare’s newly finalized 2017 Physician Fee Schedule (PFS). Next year’s PFS significantly updates CCM, offering new codes for complex chronic care management and for extra care management furnished by a physician or practitioner following the initiating visit for patients with multiple chronic conditions.

    “For us, CCM is not really focused on the near term revenue as much as it is about the long term action-reaction we can have in the patient’s life, and how our physicians are paid over the next three years.”

    Click here for an interview with Barry Allison on the MACRA Prerequisite of Procuring QRUR Performance Data to Maximize MIPS Success.

    5 Ways to Keep Pace with MACRA Momentum

    September 15th, 2016 by Patricia Donovan

    carecompactsIn a nod to the wide diversity of physician practices, the recent “Pick Your Pace” announcement by the Center for Medicare and Medicaid Services (CMS) clarifies the timing of reporting for year one of the Quality Payment Program and offers eligible physicians and other clinicians multiple options for participation.

    But whatever participation level a practice elects for 2017, there are many ways eligible providers can proactively prepare for MACRA’s ultimate impact on physician quality reporting and reimbursement prior to November 1, 2016, the date by which CMS has said it will issue the MACRA final rule.

    Eric Levin, director of strategic services, McKesson, offered this advice for physician practices to prepare for Medicare’s Merit-based Incentive Payment System (MIPS), one of two payment paths CMS will offer to practices.

    • First, make certain you are successfully participating in any Medicare Quality and electronic health record (EHR) programs, which would include the Physician Quality Reporting System (PQRS), Meaningful Use, and the Patient-Centered Medical Home.
    • Next, try and factor the alternative payment model (APM) participation bonus into your risk-based payment model adoption strategy to see if that might be something you can qualify for, as the rewards can be significantly higher under the APM track.
    • Third, make sure you know which track your organization is going to seek. Explore APMs; if you can do one, great. If not, then MIPS can still provide a relatively high incentive.
    • Next, start educating providers, employers, nurses, staff members, on what the payment track is going to be, what’s going to be measured, and what the outcomes will be like as well.
    • Finally, stay very close to CMS. Check their Web site, subscribe for e-mail updates and check their Twitter feed for anything that’s changed, for any proposed MACRA rules that might become final, so that you are aware of and can make any changes as needed.
    • Source: MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System

      http://hin.3dcartstores.com/Post-Acute-Care-Trends-Cross-Setting-Collaborations-to-Align-Clinical-Standards-and-Provider-Demands_p_5149.html

      MACRA Physician Quality Reporting: Positioning Your Practice for the MIPS Merit-Based Incentive Payment System delivers a veritable MACRA toolkit for physician practices, with dozens of tips and strategies that lay the groundwork for reimbursement under Medicare’s Merit-based Incentive Payment System (MIPS), expected to begin in 2017 and one of two payment paths Medicare will offer to practices.

    MACRA Mantra for Physician Practices: “Chase the Quality, and the Dollars Will Follow”

    July 19th, 2016 by Patricia Donovan

    Physician practices should position themselves to be paid for volume now and value in the future, McKesson’s Eric Levin advised webinar participants.


    If provider discontent doesn’t prompt a delay, the controversial MACRA legislation will become reality in just six months, shaking up traditional physician reporting and reimbursement as healthcare knows it.

    And while the proposed MACRA rule is still in flux, the bones of the law aren’t expected to change, notes Eric Levin, McKesson’s director of strategic services. From this point forward, he says, care coordination will be the ticket to success in eventual MACRA value- and performance-based healthcare models.

    “As clinical alignment and care coordination increase, if you are not participating in some type of value-based care program, most likely you’re not being reimbursed or rewarded for that work,” Levin told participants in The New Physician Quality Reporting: Positioning Your Practice for MACRA’s Merit-Based Incentive Payment System, a July 2016 webinar now available for replay.

    In outlining MACRA’s intent, Levin chiefly focused on the Merit-Based Incentive Payment Systems (MIPS) rather than the second reimbursement path, alternative payment systems (APMs), since the majority—88 percent—of physicians is expected to qualify under MIPS rather than APMs.

    Zeroing in on MIPS, Levin reviewed eligibility, performance categories and data submission options, among other points. He then detailed the plethora of current and planned technical assistance options from CMS—including eventual practice transformation networks to provide peer-level support to physicians—before offering practical ways physician practices can prepare now for MACRA.

    His six immediate action steps for practices included dipping a toe into analytics and data aggregation. “Look at the data. Learn how to risk-stratify. See the gaps in care you currently have and where those can be filled in so you’re not just measuring but actually improving quality,” Levin advised. The CMS Quality and Resource Use Report is useful for estimating a practice’s MIPS score, he added.

    In offering six additional tactics to become MACRA-ready, Levin recommended physician practices acquaint themselves with national benchmarks as a primer in quality measurement.

    And on Levin’s accompanying five-point MACRA implementation checklist is a reminder to stay current on CMS’s proposed and final MACRA rulings. Fostering relationships with technology vendors wouldn’t hurt either, he added.

    His final points covered additional MACRA implementation resources, including education from provider associations, as well as the benefits of Patient-Centered Medical Home recognition and engagement in CMS’s Chronic Care Management initiative in MACRA preparation.

    “These programs will really help you begin the value-based journey if you have not started.”

    Levin emphasized providers should not wait for the final rule. Rather, physician practices should “learn how to focus on quality outcomes and costs, helping focus on the patient as well as that patient-provider relationship. Look at how you can identify ways to increase inexpensive patient encounters.”

    Before concluding, Levin answered participants’ questions on how MACRA and MIPS will impact specialty providers; lessons practices can take from participation in the Physician Quality Reporting System, Meaningful Use and other value-based initiatives to enhance MACRA success; recommendations for small and solo practices; and other key concerns.

    Learn more about Levin’s presentation.