MACRA - What’s In Store for Independent Practices
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The webinar presented by John Lynn on July 13, 2016, covers the Medicare Access and CHIP Reauthorization Act (MACRA), detailing the transition from existing quality reporting programs to a streamlined framework featuring MIPS and APMs. It emphasizes the benefits of being part of an advanced APM and outlines the MIPS performance categories and scoring system, including updates on support for small practices. Additionally, the session discusses how Kareo's solutions can assist practices in adapting to these changes.
MACRA - What’s In Store for Independent Practices
- 1. webinar MACRA What’s In Store for Independent Practices Presented by John Lynn July 13, 2016
- 2. @GoKareo Agenda 2 Agenda 2 • Welcome & Introductions • MACRA • How Kareo Can Help • Your Questions
- 3. @GoKareo 33 Connect via Social Connect with us via social media How to connect: 1) Follow @GoKareo on Twitter 2) Follow @LeaChatham on Twitter 3) Follow @techguy on Twitter twitter.com@GoKareo facebook.com/GoKareo linkedin.com/company/kareo
- 4. @GoKareo 44 Speaker John Lynn Editor & Founder HealthcareScene.com, a network of 10 EHR and HIT blogs Co-founder of InfluentialNetworks.com & Physia.com Blogs have published over 10,000 healthcare IT posts with more than 18 million views
- 5. @GoKareo Agenda 5 Agenda 5 • Welcome & Introductions • MACRA • How Kareo Can Help • Your Questions
- 6. @GoKareo 66 Move to Value and Quality
- 7. @GoKareo 77 What is MACRA? Medicare Access and CHIP Reauthorization Act of 2015 • Replaces Sustainable Growth Rate (SGR) and the annual "Doc Fix" • Single Framework - Quality Payment Program Streamlines Multiple Quality Reporting Programs Into • APMs (Advanced Alternative Payment Models) • MIPS (Merit-based Incentive Payment System) Currently a Proposed Rule • Public Comment Period Ended June 27th • Final Rule – October 2016?
- 8. @GoKareo 8 Most Small Practices Will Do MIPS! CMS Expects Most Will Move from MIPS to APM Over Time
- 9. @GoKareo 99 Are You Part of an APM? Who's Considered an Advanced APM in 2017? • Shared Savings Program (Tracks 2 and 3) • Next Generation ACO Model • Comprehensive ESRD Care (CEC) (large dialysis organization agreement) • Comprehensive Primary Care Plus (CPC+) • Oncology Care Model (OCM) (two-sided risk track available in 2018)
- 10. @GoKareo 1010 What’s the Benefit of Being an Advanced APM? •Up to 5% Bonus Starting in 2019 through 2024 •Higher Fee Schedule Update in 2026 The MACRA APM Creates Extra Incentives, It Doesn't Change Current APM Functions or Rewards Value
- 11. @GoKareo 1111 Most Small Practices Won’t be Advanced APMs Advice for Those Who Might Be in an APM: • Consult Your ACO or other APM Organization Ask: • Are You a Qualified APM Participant (QP)? Only Advanced APMs (QPs) Are Excluded from MIPS
- 12. @GoKareo 1212 MIPS Details Replaces 3 Programs: • PQRS • Medicare EHR Incentive Program (Meaningful Use) • Value-Based Payment Modifier (VBM) These Programs Go Through 2018 New Program: • Clinical Practice Improvement Activities (CPIA)
- 13. @GoKareo 1313 MIPS Details Worth Noting: • Medicaid EHR Incentive Program will Continue • Medicare EHR Incentive Program for Hospitals Will Continue Immediate Timeline: • First Performance Period is 2017 • MIPS Adjustments Happening in 2019
- 14. @GoKareo 1414 Who's Eligible for MIPS?
- 15. @GoKareo 1515 Who's Not Eligible for MIPS?
- 16. @GoKareo 1616 What's the MIPS Incentive or Penalty?
- 17. @GoKareo 1717 MIPS - 4 Performance Categories Note: “Resource Use” is sometimes called “Cost”
- 18. @GoKareo 1818 Performance Category Weighting MIPS 100 Point Scale
- 19. @GoKareo 1919 MIPS Composite Performance Score • MIPS Performance Score Compared to Threshold - Determines Adjustment You Receive • CMS Intends to Publish the Benchmarks and Thresholds Prior to 2017 • Gives Credit for Partial Performance • Scaling Factor to Keep Program Budget Neutral • Exceptional Performance Incentive ($500 Million Available)
- 20. @GoKareo 2020 Quality Performance Category PQRS Replacement • Reduction from 9 to 6 measures • No Domain Requirement Changes • Close to 300 Measures Available • Specialty Specific Measure Sets • Year 1 Weight - 50%
- 21. @GoKareo 2121 Resource Use (Cost) Category Value Modifier Replacement No Data Submission Required • Calculated Based on Claims Changes: • Added 40+ Episodic Specific Measures • Year 1 Weight - 10%
- 22. @GoKareo 2222 Clinical Practice Improvement Activities Category New Category (CPIA) • 90+ Activities to Choose From • Minimum of One Activity • Small practices (15 or fewer professionals) - Two Activities = Full Credit • Patient Centered Medical Home = Full Credit • APM Participation = 50% Credit • Year 1 Weight - 15%
- 23. @GoKareo 2323 Advancing Care Information Category EHR Incentive Program (Meaningful Use) Replacement Changes: • May Participate as Individual or Group • Year 1 Weight - 25%
- 24. @GoKareo 2424 Advancing Care Information Scoring Score within a Score (25% of Total MACRA Score)
- 25. @GoKareo 2525 Advancing Care Information Still Includes Base Score (Reporting) • Protecting PHI • ePrescribing • Patient Access • Patient Engagement • HIE • Public Health and Clinical Data Registry Reporting Performance Score • Patient Electronic Access • Coordination of Care through Patient Engagement • HIE
- 26. @GoKareo 2626 Advancing Care Information Changes • Removed "All or Nothing" Approach from EHR (Meaningful Use) Program • Removed Redundant Measures • Eliminated CPOE and CDS Objectives • Reduced the Number of Required Public Health Registries
- 27. @GoKareo 2727 Small Practice Support for MACRA $20 million/year from 2016-2020 to Small Practices • Provides Technical Assistance with MIPS or Transition to an APM Concept of a "Virtual Group" • Not Available Until 2nd Year of Program Accommodations for Small Practice Reporting for: • Quality Category • Cost Category • Clinical Practice Improvement Category
- 28. @GoKareo 2828 MACRA Comment Period 134 Physician Events – 60,000 Participants 3,710 Formal Comments Received General Feedback • Delay the January 1, 2017 Start Date • 90 Day Reporting Period for 1st Year of Advancing Care Information • MU Stage 3 Requirements Should Be Delayed Until 2018 • More Simplification • APMs Aren’t Accessible to Most (Which is Bad) • Data Blocking Attestation Requirement is Controversial
- 29. @GoKareo 2929 Medicare Fee Schedule Changes
- 30. @GoKareo 3030 How Do You Fit Into MACRA?
- 31. @GoKareo Agenda 31 Agenda 31 • Welcome & Introductions • MACRA • How Kareo Can Help • Your Questions
- 32. @GoKareo 3232 Awards and Rankings Growth awards The speed at which medical practices are moving to Kareo and referring it to other providers. Best places to work Happy, engaged employees stay longer, have more experience and offer better customer service Analyst reviews 3rd party recognition, driven by direct customer feedback, equals trust and credibility
- 33. @GoKareo 3333 Kareo Platform Kareo Billing • Centralized A/R Management • Intuitive Billing Analytics • Easy & accurate charge capture • ICD-10 Ready • Smarter billing/patient collections • Secure messaging • Powerful scheduler/appt. reminders
- 34. @GoKareo 3434 Kareo Platform Kareo Clinical • Comprehensive dashboard • Simple charting • Easy ePrescribing • Convenient eLabs • Specialty templates • Electronic Superbill • Integrated Patient Portal • Secure messaging
- 35. @GoKareo 3535 Kareo Platform Kareo Managed Billing • Dedicated team of specialists • Simple scheduling/calendar • Charge Capture (web/mobile) • Nationwide Billing Rules Engine • Claims tracking • Billing Tasks • Billing Analytics
- 36. @GoKareo 3636 Kareo Platform Kareo Marketing • Marketing and front office automation • Online visibility and SEO • Online appt. scheduling • Email, text & voice recording appt. reminders • Post visit patient reviews • Practice analytics for ROI • Patient communications
- 37. @GoKareo Agenda 37 Agenda 37 • Welcome & Introductions • MACRA • How Kareo Can Help • Your Questions
- 38. Connect with Kareo Stop by and say hi! Kareo @GoKareo GoKareo Kareo 3353 Michelson Drive, Suite 400 Irvine, CA 92612 (888) 775-2736
Editor's Notes
- #8: http://go.cms.gov/QualityPaymentProgram
- #10: CMS’ Technical Definition APM Includes: CMS Innovation Center model MSSP (Medicare Shared Savings Program) Demonstration under the Health Care Qaulity Demonstration Progrma Demonstration Required By Federal Law
- #12: Advanced APMs (Criteria) Use Certified EHR Base Payment on Quality Bears Financial Risk or Medical Home Model See: https://engage.vevent.com/index.jsp?eid=3536&seid=380
- #19: Special circumstances of small practices, rural areas, and non-patient facing clinicians – Can exclude a category and decrease the scale
- #26: Shift to focus on Patient Access and Health Data Exchange
- #28: See: https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Small-Practices-Fact-Sheet.pdf
- #33: Kareo has received extensive industry recognition, including the Deloitte Technology Fast 500, Inc. 5000 and Black Book’s #1 Integrated EHR, Practice Management and Billing Vendor.