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Value-Based Care

Understanding healthcare reform and how reimbursement is changing

What is MACRA and how does it affect your practice?

In this brief overview video, we explore how MACRA combines fee-for-service, value-based modifiers and meaningful use incentives to create a new quality-focused reimbursement model.

Learn more about MACRA and how it impacts you.

"Every dollar you're paid by CMS is going to change, and the measurement year is earlier than you think."

- Arien Malec, Vice President, McKesson RelayHealth1

Important changes for Medicare reimbursement

Compliance with the Medicare Access and the Children's Health Insurance Program Reauthorization Act (MACRA) Quality Payment Program (QPP) can lead to positive or negative adjustments for Medicare reimbursement.

To help avoid negative adjustments in 2019, most2 pracitioners will need to start reporting data in 2017. You can select one of these options for the 2017 reporting year3:

Option 1: Test of data submission

If you submit a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017), you can avoid a downward payment adjustment.

Option 2: Partial-year participation

If you submit 90 days of 2017 data to Medicare, you may earn a neutral or small positive payment adjustment.

Option 3: Full-year participation

If you submit a full year of 2017 data to Medicare, you may earn a moderate positive payment adjustment.

Option 4: The Advanced Alternative Payment Model (APM)

Participate in an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3, in lieu of reporting quality data to the Quality Payment Program.

For those required to report, doing nothing will result in penalties.

Not sure what to do about MACRA?

You're not alone. A recent study4 found that only half of the physicians surveyed were familiar with MACRA. Under MACRA, the QPP introduces important changes for Medicare reimbursement, including MIPS and APMs.


The Merit-based Incentive Payment System (MIPS)

The proposed rule allows clinicians to choose measures and activities appropriate to the type of care they provide. MIPS allows Medicare clinicians to be paid for providing quality care demonstrated and measured in four performance categories:

Clinical Practice Improvement Areas (CPIA)

Clinicians can choose the activities best suited for their practice; the rule proposes more than 90 activities to choose from. Examples include:

  • Expanded practice access
  • Beneficiary engagement
  • Population management
  • Care coordination
  • Practice safety and assessment
Advancing Care Information (ACI)

Clincians will report key measures of interoperability and information exchange. Clinicians are rewarded for their performance on the key measures they select. Key measures include:

  • Patient electronic access
  • Coordination of care through patient engagement
  • Health information exchange

The Quality performance category replaces the Physician Quality Reporting System (PQRS). Examples of quality reporting requirements include:

  • Effective clinical care
  • Patient safety
  • Communication and care coordination
  • Efficiency and cost reductions

Some examples of MIPS Quality Measures include:*

  • Diabetes: Eye Exam
  • Screening for osteoporosis for women aged 65-85 years of age
  • Chronic Obstructive Pulmonary Disease (COPD): Spirometry evaluation
  • Preventative care and screening: Influenza immunization
  • Care planning

CMS will calculate these measures based on claims and availability of sufficient volume. Clinicians do not need to report anything additional.

The cost category will be calculated in 2017, but will not be used to determine your payment adjustment in 2019.

Access our solutions and resources to help you prepare and report. We offer a broad and dynamic network of trusted alliances with technologies and services to help you thrive in the new reimbursement models.

View Solutions


Need help navigating value-based care?

Access our solutions and resources to help you prepare and report. We offer a broad and dynamic network of trusted alliances with technologies and services to help you thrive in the new reimbursement models.

View Solutions
Webinar Replay

High Performing Primary Care: Helping Practices Transition to Value-Based Purchasing

In this Webinar Wednesday Replay, we discuss the changing paradigm of payment under the Medicare Access and CHIP Authorization Act and how you can prepare for value-based payment.

Webinar originally aired on November 16, 2016.

Watch Webinar Replay

How to Manage and Maintain Annual Compliance Training

Many organizations have one person who maintains responsibility for ensuring that staff receive and complete their compliance training. This can be a daunting task. Is an eLearning system right for your organization? What should you consider when exploring eLearning options?

Brian S. Williams, MedTrainer's Compliance Director, provides his insight.

Read Full Article
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