MACRA and the

Pennsylvania Medical Society’s Practice Options

Initiative Jaan Sidorov, MD

Care Centered Collaborative of the

Pennsylvania Medical Society

Outline

• A review of “what you need to know” to succeed in MACRA

• An examination of why the MACRA law passed and will remain the law of the land under the Trump Administration.

• A discussion of what to look for in a MACRA data registry partner

• An update on what the Practice Options Initiative is doing to support patient care through a statewide MACRA service offering.

Outline

Please feel free to send your questions at any time by using your question panel on the screen.

This webinar is being recorded and will be made available later on the PAMED website.

To review….

Medicare Access and CHIP Reauthorization Act • Ended the Sustainable Growth Rate & yearly “Doc Fixes” • Medicare Part B Value over Volume • Streamlined PQRS, Value-Based Modifiers, & Meaningful

Use (“MU”) • Still fee-for-service, but +/- 4% in 2019 • Individual or Group Reporting • Public reporting • Other payors likely to follow • Merit-based Incentive Payment System (“MIPS”)

• Quality, Cost, Advancing Care Information (ACI) and Clinical Practice Improvement Activities (CPIA)

To Review

For 2017, > $30,000 in Medicare Part B allowed charges and > 100 Medicare patients. **Must** use a reporting intermediary: • QCDRs, • Other qualified registries, or • Electronic Health Record Quality Measures: • Numerator/Denominator • (# meeting quality measure)/(# meeting condition criteria) • Must report on at least 50% patients that meet the measure’s

denominator criteria, regardless of payor 0-100 points, with a 3 point threshold for the minimum

Quality: Report at least six quality measures: 60 points ACI and CPIA are based on “Attestation” ACI: Protecting PHI, ePrescribing, health information exchange etc….. CPIA: Full credit for NCQA, URAC or other Patient Centered Medical Home (PCMH); there are other improvement activities….

To review….

Quality: Report at least six quality measures: 60 points ACI and CPIA have “Attestation Options” ACI: Protecting PHI, ePrescribing, health information exchange etc….. CPIA: Full credit for NCQA, URAC or other Patient Centered Medical Home (PCMH); Otherwise other improvement activities….

To review….

Passed the House on March 26, 2015 (392–37) Passed the Senate on April 14, 2015 (92–8) Signed into law by President Barack Obama on April 16, 2015

Physician Support for MACRA? Drew et al: Provider perspectives on APMs. Pop Health Manag Jan. 2017

N=242 with an interest in population health. Likert 1 (strongly disagree) - 5 (strongly agree)

Domain Overall Health System Leader

Physician Leader

Non-leader

Physician

P value

… changes in my practice/system have hindered its ability to provide high-quality care.

3.00 (1.19)

2.61 (1.05)

3.16 (1.26)

3.27 (1.12)

P<.05

… I feel more professionally satisfied.

2.69 (1.13)

3.11 (0.89)

2.46 (1.23)

2.54 (1.10)

P<.05

… my practice/system has hired new staff to manage patients effectively

3.41 (1.39)

4.05 (1.14)

3.20 (1.39)

2.83 (1.40)

0.001

Attitudes Toward Alternative Payment Models (AAPM) Scale

3.05 (0.52)

3.28 (0.42)

2.91 (0.57)

2.95 (0.47)

0.003

Under Alternative Payment Models……

http://online.liebertpub.com/doi/full/10.1089/pop.2016.0128

Budget Neutral

Budget Neutral

(Plus $500 million for exceptional performance)

http://www.thedifferentialdx.com/how-mips-will-affect-physician-reimbursement-in-2017-beyond/

Budget Neutral

Budget Neutral and

Win-Win

Patients: higher quality, same price

Physicians Recognized for quality

Where to Now?

MACRA Has Already Started

MIPS Reporting Options: “Anything, Something, Everything”

2017 is a flexible and transition year; impact on payment begins 2019

• Report anything (from any 90 day period) in 2017: Get 3 points & avoid the 4% Part B reduction;

• Report something in 2017: Get 4 or more points & maybe get a partial upward adjustment in Part B

• Report everything in 2017: Get 4 or more points & more likely to get up to a 4% payment boost in Part B

Report Anything

One Clinical Practice Improvement Activity (CPIA); examples include….. • Depression screening and follow-up plan:

Regular engagement in integrated prevention and treatment interventions, including depression screening and follow-up plan (refer to NQF #0418) for patients with co-occurring conditions of behavioral or mental health conditions.

• Implementation of fall screening and assessment programs to identify patients at risk for falls and address modifiable risk factors (e.g., Clinical decision support/prompts in the electronic health record that help manage the use of medications, such as benzodiazepines, that increase fall risk).

• Use of tools that assist specialty practices in tracking specific measures that are meaningful to their practice, such as use of the Surgical Risk Calculator.

One Advancing Care Information (ACI); examples include….. • Electronic prescribing: At least one prescription

is queried for a drug formulary and transmitted electronically using certified EHR technology.

• Send a summary of care: For at least one transition of care or referral, (1) creates a summary of care record using certified EHR technology; and (2) electronically exchanges the summary of care record.

• Secure messaging: For at least one unique patient seen by the MIPS eligible clinician during the performance period, a secure message was sent using the electronic messaging function of certified EHR technology to the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative), or in response to a secure message sent by the patient (or the patient-authorized representative).

One quality measure, even just one patient…. OR

OR

Report more than anything Something… 90 days

Can try again if 1st submission isn’t “good.”

• Internal review

• Comparison to benchmarks

• Other

Reporting Intermediary “QCDR”

Data submission via EHR, a Registry or a “QCDR”

Qualified Clinical Data Registry:

• a CMS-approved entity that collects clinical data on behalf of clinicians for data submission.

• also intermediates other data submissions to CMS

• must meet requirements in data capture, verification processes, performance calculations, getting audited

The QCDR reporting option is different from a traditional registry or an EHR system:

• not limited to Medicare patient data, but across all payors.

• can host other “non-MIPS” measures approved by CMS for reporting.

Reporting Intermediary “QCDR”

What to look for:

• Customer service

• Tenure

• Service standards

• Functional and Technical Capabilities

and

Be prepared to commit time & effort

Reporting Intermediary “QCDR”

Reporting Intermediary QCDR

Look for…..

turnkey

dashboard

comparison benchmarks: do over?

…. With the three options:

Anything

Something

Everything

Other Reporting Tips

Check your benchmarks….. • Physician Compare reports https://www.medicare.gov/physiciancompare/

• Quality and Resource Use Reports (QRURs) including readmission rates. https://portal.cms.gov/wps/portal/unauthportal/pvlandingpage_wsrp

• PECOS or the “Provider Enrollment, Chain and Ownership System” to confirm how your cost data will be evaluated against correct specialty performance benchmarks;

https://pecos.cms.hhs.gov/pecos/login.do

Be educated! • PAMED has a Comprehensive 12-page MACRA Guide https://www.pamedsoc.org/Pages/Tools%20You%20Can%20Use%20Specific/MACRA-Support.aspx

Know where the data for each measure resides • And if you use an EHR, ask the vendor about making sure that quality activities are

mapped correctly

Keep documentation for everything you attest to; take screen-shots, keep reports and file them for seven years

Anything, Something, Everything… NOTHING is not an option

Patients win:

• Higher quality, budget neutral

Physicians win

• Graded on the “curve”

• Find a good QCDR

Credit Wikipedia https://commons.wikimedia.org/w/index.php?search=head+in+the+sand&title=Special:Search&go=Go&uselang=en&searchToken=2up8si9clpsqp9kfk4og3dclj#/media/File:Bury_your_head_in_the_sand.jpg

What is the Pennsylvania Medical Society Doing? [to be] the voice of Pennsylvania's physicians, advancing quality patient care, the ethical practice of medicine, and advocating for the patients they serve.

PAMED’s Commitment: Improve the health of patients, families, and communities as we advocate for physicians and their patients. Advance physician leadership, enhance professional satisfaction, promote the delivery of affordable, quality healthcare; and strengthen the physician-patient relationship. Serve our members efficiently and effectively and continually evaluate and adapt our performance to meet member needs, and demonstrate member value.

PAMED’s

Practice Options Initiative

Serving Pennsylvania Patients by:

1) Partnering with physician-led practices,

2) Investing in value-based care,

3) Supporting PAMED’s members When we asked how, we heard…..

MACRA Readiness

Care Management

Pt. Coverage Denials & Appeals

Group Health Insurance

Safety & Regulatory Compliance

Performance Improvement

PAMED’s

Care Centered Collaborative

“Practice Options Initiative”:

• Created by PAMED to assure Pennsylvania physician success with value-based care

Named the Care Centered Collaborative to reflect our patient-centered commitment:

• MACRA-MIPS support, then….

• Practice service support, then….

• Value-based service recognition across all payors

Patient-Centered. Physician-Led.

Partnership

P

What’s Next? Collaborate with one statewide MACRA Service Provider: • High Value for Patients

– Enable greater quality delivery – e.g. dashboards

• High Value for Physicians – Build on clinical excellence – e.g., achieve a quality bonus

• QCDR • Understands Physician Practice & Is Service Oriented • Adaptable to/Sustainable in any Practice Setting • Established Track Record • “Turnkey” • Repeat: Understands Patient and Physician Needs

PAMED’s

Care Centered Collaborative

Want to learn more on how the Collaborative can serve you and your patients? Follow us at…. www.pamedsoc.org/POI Contact us at……. KnowledgeCenter@pamedsoc.org

- or – (855) 726-3348 Tell us you're calling about the MIPS-MACRA Support Program.

KEEP CALM

and

DO MACRA

The Next Maximize Your Membership Webinar

Mark your calendar:

• Wednesday, April 12, noon until 1 PM. Topic:

• Options for protecting your income through life and disability insurance products offered to PAMED members through The Glatfelter Agency.

Learn more and register online at: www.pamedsoc.org/MaximizeYourMembership