alternative payment models

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The Medicare Access and CHIP Authorization Act,
(MACRA),has been met with widespread relief
and a tad bit of suspicion. As always conspiracy
theories and unanswered questions are in the air
Here are 10 major questions that everybody wants
an answer for
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Here are 10 major questions that everybody wants
an answer for.
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What exactly is MACRA?
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How will MACRA impact payments?
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Tell me more about MIPS
Taking Action
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Am I eligible to participate in MIPS?
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Will MACRA eliminate fee for service?
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What should I do prepare myself for MIPS?
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What are the data submission requirements of
MIPS?
Taking Action
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What should I do prepare myself for MIPS?
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Will MACRA eliminate fee for service?
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What should I do prepare myself for MIPS?
Taking Action
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What exactly is MACRA?
The Medicare Access and CHIP Authorization Act,
(MACRA), will permanently replace the dreaded
Sustainable Growth Rate formula for determining
payments.
MACRA seeks to
Provide payments based on quality and outcomes
rather than volume.
Health information technology will play a major
role .
To consolidate major incentive programs like
PQRS, value based payment modifier, Meaningful
Use and the Medicare Electronic Health Record
incentive program into one single, comprehensive
framework.
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How will MACRA impact payments?
There are 2 paths for payment in the MACRA
legislation.
The Merit Based Payment System (MIPS)
Alternative Payment Models (APMS)
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Tell me more about MIPS
Eligible clinicians will be evaluated based on 4
categories
Quality- based on the existing PQRS system
Resource use based on the Value based payment
modifier model
Advancing Care Information which is similar to
MU mandates
Clinical practice improvement categories
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4
Am I eligible to participate in MIPS?
You are eligible if you are a physician,
registered nurse practitioner, clinical nurse
specialist, certified registered nurse
anaesthetist.
Going forward, the secretary may broaden the
eligible clinician group to make occupational
therapists, speech language pathologists and
nutritional professionals to become eligible to
participate in MIPS as well.
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Will MACRA eliminate fee for service?
MACRA preserves the fee for service model.
Physicians who follow the fee for service model
can participate in the MIPS program.
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What are the data submission requirements of
MIPS?
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MACRA intends to follow a single, unified data
submission method for all the performance
categories.
To achieve this goal MIPS expands on the existing
quality measures and simplifies the data
submission process.
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What should I do to prepare myself for MIPS?
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If you are already reporting quality measures
under the existing incentive programs identify
and focus on your high performing quality
measures.
Evaluate and educate your staff on QRUR (quality
resource and use report) by CMS and see how
improvements can be made .
Analyse your PQRS feedback reports and monitor
your current quality metrics across Medicare and
private payers.
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What is the Advanced Alternative Payment Model?
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AAPMs are performance based payment methods that
CMS will follow to reimburse physicians who care
for Medicare beneficiary. CMS will release a list
annually on the care models that qualify for
AAPM incentives.
Providers who participate in qualifying AAPMs
will be eligible for APM payments and bonuses
and are exempt from participating in MIPS.
However, all providers will report under MIPS in
2017. CMS will take a decision on the clinicians
who will qualify for APM status.
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What are the eligibility criteria for
participating in AAPMs?
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Providers will have to use certified EHR
technology, base payments on quality measures
akin to MIPS and shoulder monetary risk for
financial losses incurred.
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How do I prepare myself to participate in AAPMs?
Choose quality measures that have a higher chance
of success
Identify opportunities to improve patient care
and achieve savings for payers
Implement clinical and financial strategies to
help meet your chosen quality measures
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cra-faqs/