Posts Tagged ‘Merit-Based Incentive Payment System’

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.

    ACOs: MSSP Commitment Hinges on MACRA Advanced APM Bonus Eligibility

    June 2nd, 2016 by Patricia Donovan

    ACO

    A new NAACOS report polls ACOs on operating costs, MACRA and risk readiness.

    More than half—56 percent—of accountable care organizations (ACOs) in the Medicare Shared Savings Program (MSSP) indicated they would leave the MSSP program if their ACOs were not eligible for the 5 percent Advanced Alternative Payment Model (APM) bonus under MACRA, according to a May 2016 survey by the National Association of ACOs (NAACOS).

    A third of ACOs said they would stay in the MSSP program even if deemed ineligible for the bonus, the NAACOS survey found.

    The Alternative Payment Model is one of two paths for participation in the quality improvement programs included in the MACRA legislation for eligible professionals; the other is the Merit-Based Incentive Payment System (MIPS).

    Currently, MSSP Track 1, a one-sided payment model, is not among the models that would qualify for the APM track—which CMS calls “Advanced APMs”—under the proposed MACRA rule; however, the MSSP Tracks 2 and 3, Next Generation, and Pioneer ACO programs, which all require downside risk, would qualify as APMs.

    Approximately 411 MSSP ACOs, or 95 percent, participate in Track 1 of the program, according to April 2016 data from CMS.

    All APM qualifying participants will receive a 5 percent lump sum bonus on their Medicare payments for 2019 through 2024. This bonus will be in addition to the incentive paid through existing contracts with the qualified APM (e.g., MSSP) demonstration program, etc.

    Beginning in 2026, these ACOs will qualify for a 0.75 percent increase in their payments each year.

    In other findings, the NAACOS survey also determined the following:

    • More than half of respondents (51 percent) describe their ongoing ACO operational costs as very significant;
    • The average total ACO operating costs for all respondents is $1.6 million per year, but the cost difference is significant between single or multi-ACOs, with single ACOs averaging just under $2 million and multi-ACOs averaging almost $1 million per year.
    • If required by CMS to take on downside risk, 43 percent said they would leave the MSSP program and about a third would stay (33 percent).
    • Over three quarters of the ACO respondents (84 percent) said they would be ready for downside risk within the next six years, with 44 percent of those even ready as soon as one to three years.

    Infographic: MACRA Countdown to Measurement Year Goals

    May 27th, 2016 by Melanie Matthews

    Under MACRA, the physician quality measurement systems in place in 2017 will determine physician Medicare reimbursement in 2019, according to a new infographic by Geneia.

    The infographic describes the pace of change in physician value-based reimbursement, the adjustments that will be made to Medicare claims starting in 2019 and three steps that practices should be taking now to be ready.

    Since the January 2015 rollout by CMS of new chronic care management (CCM) codes, many physician practices have been slow to engage in CCM. Arcturus Healthcare, however, rapidly grasped the potential of CCM to improve patient outcomes while generating care coordination revenue, estimating it could earn up to $100,000 monthly for qualified patients treated in its four physician practices—or $1 million a year.

    Medicare Chronic Care Management Billing: Evidence-Based Workflows to Maximize CCM Revenue traces the incorporation of CCM into Arcturus Healthcare’s existing care management efforts for high-risk patients, as well as the bonus that resulted from CCM code adoption: increased engagement and improved relationships with CCM patients.

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    Are You MACRA-Ready? Physician Groups Prep Members for Medicare Payment Modernization

    May 16th, 2016 by Patricia Donovan

    Physician groups digested the 962-page MACRA notice of proposed rule-making in order to distill the notice for their members.

    As they digest the HHS’s momentous proposal to modernize how Medicare provider payments are tied to the cost and quality of patient care, physician organizations are assembling arsenals of educational tools to de-mystify MACRA.

    The federal government’s first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was detailed in an April 2016 announcement.

    Just nine days after that bulletin, the AAFP arranged a town hall meeting for its members with two high-ranking CMS officials to discuss the law that will greatly influence how physicians are paid. Comments provided by CMS Acting Administrator Andy Slavitt via conference call are detailed here.

    While the HHS window to receive feedback on the proposal remains open through June 27, 2016, the AMA has created an extensive set of online resources to support physician preparations for a post-MACRA Medicare. The resources include a guide to physician-focused payment models, key points of the Merit-based Incentive Payment System (MIPS), and five things providers can do now to prepare for the legislation, among other resources, according to a May 2016 press release.

    “The core policy elements in MACRA are surfacing in other public and private insurance programs, so understanding these policies will be essential for most physician practices,” said AMA President Steven J. Stack, MD.

    The AMA’s MACRA support tools were announced in conjunction with the release of its new interactive module on practicing value-based care authored by Grace Terrell, MD, an internal medicine physician and president of Cornerstone Health Care, who shares the proven steps her clinic used to focus on patients at the center of care.

    The value-based care module is the latest in the AMA’s STEPS Forward™ collection of physician-developed practice improvement strategies.

    Also readying its membership for MACRA is the AAFP, which last week launched a comprehensive member communication and education effort related to the proposed legislation. The AAFP’s MACRA Ready site is a one-stop shop filled with resources family physicians can use right now such as the following:

    • A timeline of important MACRA dates;
    • A list of acronyms to help digest the alphabet soup associated with MACRA’s complicated regulations;
    • A “MACRA in a Minute” 60-second overview video;
    • A deep-dive review of what value-based payment means to family physicians;
    • and much more.

    In announcing the MACRA tools, AAFP President Wanda Filer, MD, MB, told family physicians that the academy’s MACRA communication plan “is designed to help simplify the transition and provide the guidance that you will need to realize the benefits of MACRA and value-based payments.”

    A recent AAFP survey indicated that some 40 percent of family physicians already were involved in some kind of value-based payment system, she noted.

    As she related the history of MACRA, Dr. Filer reminded members that the legislation not only repealed the sustainable growth rate (SGR) but also established an annual positive or flat-fee payment for the next 10 years as well as a two-track program (the MIPS, and Alternative Payment Models, referred to as APMs) for calculating Medicare payments beginning in 2019.