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What your Medicare ACO needs to know about MACRAMEDICARE ACOS AND MACRA
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Quality Payment ProgramThe Quality Payment Program will reform Medicare Part B payments for more than 600,000 clinicians.
Clinicians will choose how they want to participate in the Quality Payment Program based on their practice size, specialty, location or patient population.
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Alternative Payment
Model (APM)
Advanced APM
Merit-based Incentive Payment System (MIPS)
MIPS or APM or Advanced APM
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MIPS
Who participates in MIPS?
MIPS Participants
Medicare Part B clinicians billing more than $30,000 a year AND providing care for more than 100 Medicare
patients per year
Physicians
Physician Assistants
Nurse Practitioners
Clinical Nurse Specialists
Certified Registered Nurse Anesthetists
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Who is excluded from MIPS?
Excluded from MIPS
Clinicians below the low-volume threshold
Medicare Part B clinicians billing less than or equal to $30,000 a year OR 100 or fewer Medicare Part B patients.
Newly-enrolled Medicare clinicians.
Clinicians who enroll in Medicare for the first time during a performance period are exempt from reporting on
measures and activities for MIPS until the following performance year.
Clinicians in an Advanced APM
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MIPS Eligible Clinicians Who Practice in Critical Access Hospitals Billing under Method II (Method II CAHs)
After consideration of the public comments we received, we are finalizing our proposal that the MIPS payment adjustment will apply to Method II CAH payments under section 1834(g)(2)(B) of the Act when MIPS eligible clinicians who practice in Method II CAHs have assigned their billing rights to the CAH.
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MIPS Eligible Clinicians Who Practice in Rural Health Clinics (RHCs) and/or Federally Qualified Health Centers (FQHCs)
After consideration of the public comments we received, we are finalizing our proposal that services rendered by an eligible clinician under the RHC or FQHC methodology, will not be subject to the MIPS payments adjustments. However, these eligible clinicians have the option to voluntarily report on applicable measures and activities for MIPS, in which the data received will not be used to assess their performance for the purpose of the MIPS payment adjustment.
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What are Medicare ACOs?
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Shared Savings Program
Track 1
Shared Savings Program
Track 2 and 3
Next Generation ACO
APM
MIPS eligible clinicians in ACOs
are subject to MIPS under the APM
scoring standard
All MIPS eligible clinicians in the
APM Entity are considered a group
and will receive the same score
Advanced APM
Participating eligible clinicians
who are determined to be
Qualifying APM Participants are
exempt from MIPS.
Advanced APM
Participating eligible clinicians
who are determined to be
Qualifying APM Participants are
exempt from MIPS.
https://qpp.cms.gov/docs/QPP_Advanced_APMs_in_2017.pdf
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Participate in an Advanced
Alternative Payment Model
[Excluded from MIPS]
Test Pace MIPS Partial Year MIPS Full Year
Comprehensive List:
https://qpp.cms.gov/docs/QPP_Advan
ced_APMs_in_2017.pdf
Submit some data after January 1,
2017.
Neutral or small payment adjustment
Report for 90 day period after January
1, 2017
Small positive payment adjustment
Fully participate starting January 1,
2017
Modest positive payment adjustment
Pick your pace for participation in the MIPS transitional year 2017
Not participating in the Quality Payment Program for the transition year 2017 will result in a negative 4%
payment adjustment
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MIPS
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MIPS
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Quality Cost Improvement
Activities
Advancing Care
Information
APM Entity group
submits quality measure
data to CMS as required
under the APM.
ACOS use GPRO
No data submitted by
APM Entity group to
MIPS
No data submitted by
APM Entity group to
MIPS UNLESS the
assigned score at the
MIPDS APM level does
not represent the
maximum improvement
activities score, in which
case the APM Entity may
report additional
improvement activities
using a MIPDS data
submission mechanism.
Shared Savings Program
ACO participant TINs
submit data using a MIPS
data submission
mechanism. Next
Generation ACO Model
and other MIPS APM
eligible clinicians submit
data at either the
individual level or at the
TIN level using the MIPS
data submission
mechanism.
Table 14: APM Entity Submission Method for each MIPS Performance Category
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Advancing Care Information Performance Category1. CEHRT. Use CEHRT for the performance period.
2. Report MIPS – Advancing Care Information Objectives and Measures.
◦ Report the numerator (of at least one) and denominator, or yes/no statement as applicable, for each required measure; or Report a null value for each required measure that includes a null value as an acceptable result in the measure specification.
3. Support information exchange and the prevention of health information blocking and engage in activities related to supporting providers with the performance of CEHRT.
4. Implemented in a manner that allowed for the timely, secure and trusted bi-directional exchange of structured electronic health information with other health care providers, including unaffiliated providers, and with disparate certified EHR technology and health IT vendors.
https://qpp.cms.gov/measures/aci
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MIPS
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Quality Advancing Care
Group Practice Reporting Option (GPRO)
Clinical Information Reconciliation
Chronic Care Management (CCM)
Patient-Generated Health Data
Chronic Care Management (CCM)
Patient Empowerment Portal
Patient-Specific Education
Patient Empowerment Portal
Provide Patient Access
Patient Empowerment Portal
Secure Messaging
Patient Empowerment Portal
Send a Summary of Care Record
Request/Accept Summary of Care Measure
Chronic Care Management (CCM)
Patient Empowerment Portal
View, Download and Transmit (VDT)
Chronic Care Management (CCM)
Patient Empowerment Portal
How does Health Endeavors help MIPS APMs with MACRA?
