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GE Healthcare Camden Group Insights Blog

Infographic: 10 Things to Know About MACRA

Posted by Matthew Smith on Dec 2, 2016 1:57:48 PM

Our colleagues at Athena Health created the infographic, below, to help providers and medical practice professionals understand the complex MACRA mandate and resulting payment adjustments. 

Why settle for a neutral or small positive adjustment in 2019? Why not GO BIG with MIPS in 2017? Earn an exceptional performance-positive adjustment on top of the possible payment adjustment of up to 4%.

CMS is funding a pool of $500 million for exceptional performers who achieve a final score of 70 points or higher. With a final score between 70 and 100, (subject to the application of a scaling factor by CMS), eligible clinicians would receive a payment increase above 4% in 2019.

In addition to the positive adjustment, Going BIG would promote your clinicians’ social reputation (Physician Compare) and accelerate the shift towards value--including future participation in Advanced Alternative Payment Models.

Are you ready to Go Big and be an exceptional performer in 2017?

  • Have you successfully reported PQRS in previous years and on track in 2016?
  • Have you successfully attested to the EHR Incentive Program (Meaningful Use)?
  • On your Quality and Resource Use Report (QRUR), do you compare favorably?
  • Are you ready to move toward value-based care?

If you answered yes to these questions, you're already on your way. 

Let GE Healthcare Camden Group help you reach your MACRA potential and maximize your MIPS payments. To get started, simply click on the button below and one of our MACRA experts will contact you.

MACRA


MACRA Infographic.jpg

Topics: Infographic, Healthcare Infographics, MACRA, MIPS

MACRA Final Rule Released Revealing Changes

Posted by Matthew Smith on Oct 17, 2016 10:09:29 AM

This past Friday morning, October 15, 2016, the Department of Health and Human Services released its final rule (with a comment period) on the Quality Payment Program ("QPP"), a part of the Medicare Access and CHIP Reauthorization Act of 2015 ("MACRA").

The QPP has two tracks: the Merit-Based Incentive Payment System ("MIPS") and the Advanced Alternative Payment Model ("APM").

Compared with the proposed rule, the main changes in the final rule include:

  • support for small and independent practices
  • expansion of APM opportunities
  • flexible 2017 reporting options
  • a focus on a unified program that supports clinician-driven quality. 

CMS launched a new Quality Payment Program website where the final rule, along with educational material, can be found. This website will be a great resource for eligible clinicians as they rollout QPP activities in 2017. 

For More Information:

Learn more about the details of the final rule in GE Healthcare Camden Group's webinar: "Chart Your Course for MACRA Success" this Thursday, October 20th. To register for this complimentary webinar, please click the button below.

Webinar, MACRA

Topics: CMS, Final Rule, MACRA, MIPS, QPP, APM

This is the MACRA Webinar You've Been Waiting For

Posted by Matthew Smith on Oct 6, 2016 12:06:37 PM

Please join GE Healthcare Camden Group for a complimentary, 60-minute webinar, Chart Your Course for MACRA Success, on Thursday, October 20, 2016, at 12:00 P.M., ET.

Background:

In April 2015, the Medicare Access & CHIP Reauthorization Act of 2015 ("MACRA") was passed, ending the Sustainable Growth Rate ("SGR") formula for determining Medicare payments for healthcare providers’ services. MACRA is intended to accelerate moving care delivery toward quality and value-based reimbursement models through the new Merit-Based Incentive Payment System ("MIPS") and incentive payments for participation in certain Alternative Payment Models ("APMs").

This law has a strict timeline to implement strategy to maximize possible incentive payments, improve care delivery and design, and successfully achieve efficiencies improving cost and quality that will go into effect 2019 based on the 2017 performance reporting period. While the final details of the incentives for the new payment models will not be defined until CMS publishes the final rule in November 2016, there are several things you can begin doing to determine optimum strategy and prepare for 2017.

Overview:

In this complimentary webinar, members of the GE Healthcare Camden Group consulting team will deliver an overview of the legislative details of the new payment reform law and the implications of MACRA. They will also provide the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs.

Date:

Thursday, October 20, 12:00 P.M., Eastern

Learning Objectives:

  • Learn the timing and timeline for MACRA implementation
  • Review the two tracks for participation, APMs and MIPs
  • Examine the incentives and penalties associated with MACRA
  • Gain insight on MIPs Composite Score:
  • Understand what it will take to be successful under MACRA
  • Master the steps to take to begin the path to APMs

GE Healthcare Camden Group Presenter:

Hawkins_New.jpgCami Hawkins, Manager

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy.


To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. We will provide dial-in information and a WebEx link via email the week of the webinar.

Webinar, MACRAQuestions?

Please contact Matthew Smith at [email protected].

Topics: Webinar, MACRA, Cami Hawkins, MIPS, APM

MACRA, MIPS, and CPIA GO!: Tips for Success

Posted by Matthew Smith on Oct 5, 2016 12:56:02 PM

By Susan Corneliuson, MHS, FACHE, Senior Manager, GE Healthcare Camden Group 

Pokémon GO!, a sensation in the gaming world, popularized location-based and augmented gaming reality but was initially released with mixed reviews. To some the game is little more than people running around catching virtual critters that appear in their coffee or on their neighbor’s lawn at 2:00 in the morning; to others it is a game of strategy in which they pulverize rival teams by taking control of gyms. In some ways, the Merit-Based Incentive Payment System ("MIPS") is also a game of strategy with physicians pitted against each other to see who will win the most points and take control of the healthcare dollar.


The Clinical Practice Improvement Activities (“CPIA”) performance category is the new addition to the Quality Payment Program under MIPS and with it also came mixed reviews. Adding incentives to improve the clinical practice environment, a category largely missing from past quality reporting programs, was seen as a benefit to the program. However, with over 90 activities to choose from there is concern about the cost to a practice of increasing or adding up to six new activities. 

Regardless of the potential draw-backs how do we become early adopters of CPIA and succeed in this new quality environment? Let’s think of CPIA as a game in which we have to catch three to six Pokémon (activities) out of 90 potential activities to win. In Pokémon Go there is a power hierarchy: those that are found everywhere (Caterpie, Weedle, Meowth) are worth less than those that are rarer (Venusaur, Blastoise, Dragonite). The less powerful Pokémon can be found everywhere so are easier to catch but can evolve into more powerful Pokémon. 

CPIA activities are also arranged in subcategories and assigned a weight of “high” or “medium,” earning 20 or 10 points each, respectively. Full credit achievement for this category is 60 points. Higher weighted activities are aligned with CMS national priorities and programs such as the Quality Innovation Network-Quality Improvement Organization (“QIN/QIO”) or the Comprehensive Primary Care Initiative (“CPCI”).  To be successful, select activities that are:

  • Easy wins such as activities that you are already doing
  • Simple to measure, track and report
  • Easily implemented with minimal effort or cost
  • Choose high-weighted activities for maximum points when possible. To achieve the highest potential score of 100 percent or 60 points, complete 3 high-weighted activities, 6 medium-weighted activities, or a combination thereof.  

Remember, 100 percent achievement on the CPIA category is attainable since measures are selected by the practice and there are no performance thresholds established for comparison. The six proposed subcategories with examples of high and medium weighted activities are show in the table below.

CLIA Sample List of Activities with High and Medium Weightings

MIPS_TABLE.png

Source: Centers for Medicare and Medicaid Services

Examples of activities that are weighted as high include:

  • Population Management: Use of a Qualified Clinical Data Registry (“QCDR”) to access practice patterns and treatment outcomes
  • Care Coordination: Participation in the CMS Transforming Clinical Practice Initiative.

Example of activities that are weighted as medium include:

  • Expanded Practice Access: Collection of patient experience and satisfaction data on access to care and development of an improvement plan
  • Beneficiary Engagement: Access to an enhanced patient portal that provides up to date information related to relevant chronic health conditions with bidirectional communication and interactive features.

There are a few activities that are more evolved than others and therefore earn a higher point value such as a patient-centered medical home (“PCMH”) or alternative payment models (“APM”). Participation in a PCMH model or comparable specialty medical home automatically qualifies for 60 points; full credit under the CPIA category. Participation in an APM that does not quality as an advanced payment model will automatically receive 30 points or 50 percent of the maximum point value. 

There are still a lot of unknowns under MIPS with the final rule expected November 1, 2016; however, preparing early and getting a jump start on your competitors will allow for more success down the road. MIPS is a zero sum game as no additional dollars are added to the budget which means that there will be winners and losers. CMS also anticipates that the first year will be the “easiest” under CPIA, with measures continuing to evolve over time. Just like Pokémon Go!, those that jump in early will be able to evolve more quickly and will have more potential to receive positive payment adjustments down the road. 


Please join GE Healthcare Camden Group on Thursday, October 20th for a complimentary, hour-long MACRA webinar focusing on legislative details as well the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs. Please click the button, below, to learn more and register:
Webinar, MACRA


Susan_Corneliuson.pngMs. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 15 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at [email protected].

 

Topics: Webinar, Susan Corneliuson, MACRA, MIPS, CPIA

Two New Infographics to Help You Understand (and Explain) MACRA

Posted by Matthew Smith on Aug 11, 2016 2:53:14 PM

As you've likely learned, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years via two pathways:

  1. The Merit-Based Incentive Payment System (“MIPS”)
  2. Alternate Payment Models (“APMs”), which will take effect starting in 2017

These two new infographics, created by the American College of Rheumatology and the American Academy of Neurology, respectively, illustrate the two pathways and provide a visual reimbursement timeline. Links to full-size renderings of each infographic are available beneath each graphic.

To read more of GE Healthcare Camden Group's thought leadership surrounding MACRA, please link to the Insights Blog articles below:

Making Sense Out of MACRA and Alternative Payment Models

Top 10 Actions to Take Now to Prepare for MACRA

MACRA: How the New Merit-Based Incentive Payment System Will Impact Physician Practices

National Association of ACOs: MSSP Commitment Hinges on MACRA Advancecd APM Bonus Eligibility


MACRA-the-Big-Idea.pngFor full-size rendering click here


15_MACRA_Infographic_v507.png

For full-size rendering click here


MACRA

Topics: Infographic, MACRA, Alternative Payment Models, MIPS, Merit-Based Incentive Payment System, APM

MACRA: How the New Merit-Based Incentive Payment System Will Impact Physician Practices

Posted by Matthew Smith on Jul 14, 2016 4:15:34 PM

By Nidhi Chaudhary, Consultant, GE Healthcare Camden Group

Healthcare delivery and its corresponding costs are changing due to recent industry trends. Value-based programs reimburse healthcare providers for the quality of care they provide to patients. To support this, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years. MACRA has two pathways:

  1. The Merit-Based Incentive Payment System (“MIPS”)
  2. Alternate Payment Models (“APMs”), which will take effect starting in 2017.

In order for practices to survive and compete in this value-based environment, specific initiatives must be deployed this year. 

MACRA1.png

Transitioning to the MACRA MIPS model

There are currently multiple quality and value programs for Medicare providers: Physician Quality Reporting Program ("PQRS"); Value-Based Payment Modifier; and the CMS EHR Incentive Program. 

MACRA streamlines those programs into MIPS and adds a fourth category called Clinical Practice Improvement Activities. Below is an example of MIPS Scoring for Year 1:

MIPS1.png

Challenges Faced by Physicians:

  • Uncertainties surrounding the shift from volume-to-value
  • Potential reduced reimbursement for services
  • Tracking of quality and cost management
  • Optimizing electronic health record (“EHR”)/registry use

Key MACRA questions for medical groups:

  • What does the current Quality and Resource Use Report (“QRUR”) tell you?
  • What is the implementation plan for 2016 and 2017?
  • What are the right measures that should be tracked and reported? Are workflow changes required?
  • What clinical practice improvement activities will be added?
  • How will the current infrastructure support the initiatives?
  • Is additional technology required?
  • How will the composite score be optimized?
  • Do we have adequate resources and education opportunities to be successful?

How can GE Healthcare Camden Group help organizations create and navigate a MACRA roadmap for 2017?

We help organizations:

  • Identify gaps and priorities by performing a MACRA readiness assessment
  • Help groups form and facilitate a steering committee with a shared vision
  • Integrate change management methodologies to ensure success
  • Create education and communication plans
  • Develop a tactical MACRA roadmap focusing on strategic and operational objectives   
See our sample work plan and timeline below:

MACRA_Roadmap.png

If you want to get started with your own, personalized MACRA roadmap, click the button below and a GE Healthcare Camden Group MACRA expert will be in touch to start you on your way.

MACRA


ChaudharyN.jpg

Ms. Chaudhary is a consultant with GE Healthcare CamdenGroup specializing in delivering strategies, working to provide more efficient and lean processes as well as coaching leaders and management. Ms. Chaudhary joined GE Healthcare in 2007 and has extensive experience in Regulatory Affairs and Quality Engineering pertaining to both medical and pharmaceutical devices. Ms.Chaudhary has provided support for strategic and business planning while working within the business and with the medical staff at multiple hospitals. She may be reached at [email protected].

 

Topics: Value-Based Care, Payment Reform, Value-Based Contracting, Payment Models, MACRA, MIPS, Nidhi Chaudhary

National Association of ACOs: MSSP Commitment Hinges on MACRA Advanced APM Bonus Eligibility

Posted by Matthew Smith on Jun 6, 2016 1:14:09 PM
According to a May 2016 survey by the National Association of ACOs ("NAACOS"), more than half—56 percent—of accountable care organizations ("ACOs") in the Medicare Shared Savings Program ("MSSP") indicated they would leave the MSSP program if their ACOs were not eligible for the 5 percent Advanced Alternative Payment Model ("APM") bonus under the Medicare Access and CHIP Reauthorization Act ("MACRA").

A third of the ACOs said they would stay in the MSSP program even if deemed ineligible for the bonus, the NAACOS survey found.

The Alternative Payment Model ("APM") is one of two paths for participation in the quality improvement programs included in the MACRA legislation for eligible professionals; the other is the Merit-Based Incentive Payment System ("MIPS").

Currently, MSSP Track 1, a one-sided payment model, is not among the models that would qualify for the APM track—which CMS calls "Advanced APMs"—under the proposed MACRA rule; however, the MSSP Tracks 2 and 3, Next Generation, and Pioneer ACO programs, which all require downside risk, would qualify as APMs.

Approximately 411 MSSP ACOs, or 95 percent, participate in Track 1 of the program, according to April 2016 data from CMS.

All APM qualifying participants will receive a 5 percent lump sum bonus on their Medicare payments for 2019 through 2024. This bonus will be in addition to the incentive paid through existing contracts with the qualified APM (e.g., MSSP) demonstration program, etc.

Beginning in 2026, these ACOs will qualify for a 0.75 percent increase in their payments each year.

In other findings, the NAACOS survey also determined the following:

  • More than half of respondents (51 percent) describe their ongoing ACO operational costs as very significant;
  • The average total ACO operating costs for all respondents is $1.6 million per year, but the cost difference is significant between single or multi-ACOs, with single ACOs averaging just under $2 million and multi-ACOs averaging almost $1 million per year.
  • If required by CMS to take on downside risk, 43 percent said they would leave the MSSP program and about a third would stay (33 percent).
  • Over three quarters of the ACO respondents (84 percent) said they would be ready for downside risk within the next six years, with 44 percent of those even ready as soon as one to three years.

A PDF version of the full report may be downloaded here

MACRA

Topics: ACO, MSSP, Accountable Care Organizations, MACRA, MIPS

Evolving Physician Reimbursement Structures: Moving the Medical Group to Value-Based Success

Posted by Matthew Smith on May 19, 2016 10:17:08 AM

By Cami Hawkins, MHA, Manager, GE Healthcare Camden Group (originally published in Journal of Healthcare Management, May-June, 2016)

Now that the Medicare Sustainable Growth Rate ("SGR") formula has been repealed, physicians and other providers must prepare for the Merit-Based Incentive Payment System ("MIPS"). This article addresses several important questions about evolving physician reimbursement structures and provides guidance on how to succeed under the new programs.

With the passage of the Medicare Access and CHIP Reauthorization Act, what changes can physicians expect with regard to payment incentive models?

Repeal the Medicare SGR formula and passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are bringing about significant changes to the Medicare physician fee schedule and reimbursement methodology (Centers for Medicare and Medicaid Services ("CMS"), 2015). MACRA established annual positive or flat fee updates for ten years and implemented a two-track fee update thereafter. In addition, MACRA created MIPS and consolidated the current Medicare fee-for-service incentive initiatives. The law also provides a mechanism for physicians to participate in alternative payment methods, including the patient-centered medical home model and others to be defined. In repealing the SGR and passing the MACRA, Congress's intent was to move away from the fee-for-service payment methodology and toward a value-based payment system.

To continue reading, please download a PDF version of this article by clicking the button below. You will be directed immediately to the full article (no form required).

Value-Based Success


Hawkins_headshot.png

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy, and hospital/physician integrations. She may be reached at [email protected].

Topics: CMS, MACRA, Value-Based Payments, Cami Hawkins, MIPS, Physician Reimursement, Value-Based Success

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