MACRA: MIPS & APMs | The Transition to Value-Based Healthcare

MACRA: The transition to Value-Based Care has begun.

The goal? To drive better outcomes and reduce healthcare costs. Providers who foster, measure, and report on outcomes using proactive, population-based care management models will see payment premiums.

With the passing of The Medicare Access and Chip Reauthorization Act of 2015 (aka MACRA) and the release of the proposed regulation implementing MACRA’s Merit-Based Incentive Payment System (MIPS) and advanced Alternative Payment Model (APM) incentives, physicians face the most fundamental changes in reimbursement we’ve seen in decades.

View our MACRA cheat sheet

Starting in 2017, Medicare physicians will need to participate in MIPS or APM systems.

Merit-Based Incentive Payment System (MIPS)
This program applies to the vast majority of physicians and assesses physicians in four categories.

Advanced Alternative Payment Models (APMs)
Physicians who receive a percentage of payments through qualifying advanced APMs will be exempt from MIPS adjustments and eligible for other incentives.

Summary of MIPS Performance Categories

Description

% of Overall MIPS Score (2017)

MACRA-Quality

Quality

Report up to six quality measures, including an outcome measure, for a minimum of 90 days.

Groups reporting via CMS web interface: Report 15 measures for a full year.

60%

Advancing Care Information (ACI) Icon

Advancing Care Information (ACI)

Fulfill five (5) required measures for a minimum of 90 days.

Report up to nine additional measures for minimum of 90 days for additional credit.

25%

Clinical Practice Improvement Activities (CPCIA) Icon

Improvement Activities

Attest to completing up to four (4) activities for at least 90 days.

Groups with fewer than 15 participants or in a rural or health professional shortage area attest to completing up to two (2) activities for a minimum of 90 days.

15%

MACRA, MIPS, Costs

Cost Resource Use

CMS will calculate these measures based on adjudicated claims.

0%

Performance Year

Payment Year

Maximum Negative MIPS Adjustment

Maximum Positive MIPS Adjustment

2017

2019

-4%

+12%

2018

2020

-5%

+15%

2019

2021

-7%

+21%

2020 +

2022 +

-9%

+27%

What qualifies as an advanced alternative payment model (APM)?

Alternative Payment Models (APMs) offer a pathway to incentives based on existing and emerging shared risk, patient-centered care, and bundled care approaches.

The chart below shows CMS’ current portfolio of alternative payment models (the list may grow over time). Advanced APMs are models that require: use of certified EHR technology, quality reporting, and two-way or “nominal” risk as defined by the April, 2016 CMS proposed regulations. To qualify, a certain percentage of your patients or revenue must come through one of these models.

  • Shared Savings Program (Tracks 2 & 3)
  • Next Generation ACO Model
  • Comprehensive ERD Care (CEC) (Large dialysis organizations arrangement)
  • Comprehensive Primary Care Plus (CPC+)
  • Oncology Care Model (OCM) (two-sided risk tracks available in 2018)

Maximize every reimbursement dollar

NextGen Healthcare clients are achieving great results:

Our clients participate
IN OVER 33% OF ACOs
MORE THAN 40% OF
primary care clients
ARE PCMH RECOGNIZED

OUR CLIENTS HAVE
successfully attested
$1 BILLION
IN MU INCENTIVE DOLLARS

ABOUT 33% OF FQHCs
use NextGen® solutions
OVER 40% OF OUR CLIENTS
use our Health Quality Measures
a key element in value-based
CARE REPORTING

Learn more about the two Quality Payment Program paths:

Merit-Based Incentive Payment System (MIPS) & Alternative Payment Models (APMs)

Mitigating risk with fee-for-value payment models

With MACRA, the financial risk of patient care, particularly for patients with costly chronic conditions, is shifting from payers to providers. In 2019, payment will be based on performance in 2017. Now, providers must focus on linking service to value; identifying high-risk patients, engaging them in their care, and improving individual and group health results. Successfully improving these metrics results in a healthier patient population and financial benefits.

Learn more about value-based reimbursement and check out the eBook
"What You Need to Know to Realize Value-Based Revenue."

Expert help, ready when you need it

Our team of experts is ready to help.

We partner with clients to meet their strategic goals and business needs along the continuum to value-based care – starting with discovery, assessment, implementation, benchmarking, and optimization.

We develop solutions and best practice workflows, all aggregated to accelerate practice transformation and drive positive outcomes. Our services can optimize your practice to prepare you for the transition.

Get the guidance and input you need to ensure your success with MACRA and beyond. Reach out to us today at sales@nextgen.com.

IN THE MEANTIME:
NextGen Healthcare clients can visit our Health Reform page to learn more.

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