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MACRA and MIPS Changes Summarized - The MACRA Division

The new 962 page rule can certainly not be summarized very well, but I would like to highlight some key points that will be useful to Providers.

1. MACRA divides into two payment programs – MIPS – Merit Based Incentive Payment Model and APM – Advanced Alternative Payment Model.

2. MIPS/APM will begin January 1, 2017 with a full year reporting period. MIPS ends the Meaningful Use Program (not really, just changes the name to Advancing Care Information), PQRS, and value-based modifier program penalties after 2018 and consolidating them to a new system that will assess Providers under four categories:
• Quality (50%)
• Resource use (10%)
• Clinical practice improvement activities (15%)
• Advancing Care Information (25%)
Combining these four categories will contribute to a MIPS composite performance score of up to 100 points. MIPS payment adjustments are applied to Medicare Part B payments two years after the performance year.

3. MIPS/APM Timeline
• April 27, 2016 – CMS released proposed MACRA rule containing MIPS regulations
• By November 1, 2016 – MACRA final rule published (mandated by the MACRA legislation)
• January 1, 2017 – First MIPS performance year begins

4. The Meaningful Use Program will now be retitled as the “Advancing Care Information.” Although CMS and the media has focused on “the end of Meaningful Use,” MU is not ending. Of course CMS has chosen to change some of the reporting requirements from an “all or nothing” approach of Meaningful Use to a more flexible goals, the structure of the program remains with requirements very similar to those included in the MU stage 3 rule CMS released last fall.

5. Physicians participating in the Shared Savings ACO Track 3, Next Generation ACO, and CPC+ alternative payment models (such as ESCO – ESRD Seamless Care Organization) are eligible for advanced APM incentive payments in 2017. Under APM, if Providers earn the title of “Qualifying APM Participants” they will be eligible to receive a 5% lump sum bonus payment from 2019-2024, APM specific rewards, and be excluded from MIPS. For a Provider to earn this title it requires having enough payments or patients in the ESCO.

6. Nearly every change to the rule is an effort towards value based care. As noted in the rule’s Executive Summary: “This rule is needed to propose policies to improve physician payments by changing the way Medicare incorporates quality measurement into payments and by developing new policies to address and incentivize participation in alternative payment models.” Submitted by Sandeep Bajaj, NANI

Tags: advanced payment model, APM, CMS, MACRA, meaningful use, medicare, MIPS, nephrology, shared savings

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