macra-mania! the quality payment program and him · macra-mania! the quality payment program and...

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MACRA-mania! The Quality Payment Program and HIM

Aurae Beidler, MHA, RHIA, CHC, CHPS

Fall Institute – Oct 7, 2016

Objectives

� Understand the changing landscape of healthcare reimbursement

� Where we’re at now and where we’re headed

� How does your role in data integrity affect provider reimbursement

� Consolidated reporting = more or less work?

� Tips for preparation

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https://youtu.be/7df7cHghaS4

Paying for Value

How to pay for value

� Proposed regulation to be worked out in the final rule

� Due Nov 1st

� Over 400 comments

� Lots of push back and request for clarifications

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Shifting Payment Models

Two issues:

� There is a move in healthcare to shift payment models to pay for value.

� How does that work at the individual physician model?

� Is this the early stage of ACOs – where it takes several rounds to get it right?

� Relationship of MACRA to other changing payment models

MACRA

Medicare Access and CHIP Reauthorization Act (MACRA)

� Makes 3 important changes to Medicare reimbursement

1. Ending the Sustainable Growth Rate (SGR) rate

2. Pay for better care, not just more care

3. Combining existing quality reporting programs into one new system: Quality Payment Program

1. PQRS, Value-based Modifier (VBM) and MU sunset on Dec 31, 2018

2. MIPS begins Jan 1, 2019

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MIPS

Merit-based Incentive Payment System (MIPS) Basics

� Can be positive, negative or zero payment adjustment

� If criteria met, could receive 5 percent incentive payment for 6 years

� Most physicians (90%) will choose this option

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program-MACRA-NPRM-slides-short-version.pdf

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“Pick Your Pace” Options

� Announced by CMS on Sept 8th – 3 MIPS options for participation and 1 APM option

� Allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017.

� Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019.

� These options and other supporting details will be described fully in the final rule.

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Option 1: Test It

� Submit some data to the Quality Payment Program, avoid a negative payment adjustment

Option 2: Participate Part of the Year

� Submit data for part of the year, even later than Jan 1, 2017 and still qualify for a small positive payment adjustment.

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Option 3: Participate for the Full Year

� For practices that are ready to go on January 1, 2017, choose to submit Quality Payment Program information for a full calendar year.

� This means your first performance period would begin on January 1, 2017.

� Could qualify for a modest positive payment adjustment.

Option 4: Join an Advanced Alternative Payment Model

� Join an Advanced Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 in 2017.

� ACOs

� Could qualify for a 5 percent incentive payment in 2019.

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https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Timeline.PDF


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Provider Compensation

� Provider compensation model change

� Restructure RVUs

MACRA Effects

Whitman, Elizabeth. 2016, Sept 3. CEO Power Panel: Are your physicians ready for reform? Modern Healthcare

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Simplification/ Consolidation

� Simplification is the goal

� Anyone remember HIPAA…

� Choice versus mandated quality measures


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Data Integrity

� CQMs – currently no thresholds for quality

� How do we know if the data reported is quality data?

AHIMA. "Data Quality Management Model (2012 update)" Journal of AHIMA 83, no.7 (July 2012): 62-71.

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Characteristics of Data Quality

� Data Accuracy: The extent to which the data are free of identifiable errors

� Data Accessibility: The level of ease and efficiency at which data are legally obtainable, within a well protected and controlled environment

� Data Comprehensiveness: The extent to which all required data within the entire scope are collected, documenting intended exclusions

� Data Consistency: The extent to which the healthcare data are reliable, identical, and reproducible by different users across applications

� Data Currency: The extent to which data are up-to-date; a datum value is up-to-date if it is current for a specific point in time, and it is outdated if it was current at a preceding time but incorrect at a later time

Characteristics of Data Quality

� Data Definition: The specific meaning of a healthcare-related data element

� Data Granularity: The level of detail at which the attributes and characteristics of data quality in healthcare data are defined

� Data Precision: The degree to which measures support their purpose, and/or the closeness of two or more measures to each other

� Data Relevancy: The extent to which healthcare-related data are useful for the purposes for which they were collected

� Data Timeliness: The availability of up-to-date data within the useful, operative, or indicated time

Davoudi, Sion; Dooling, Julie A; Glondys, Barbara; Jones, Theresa D.; Kadlec, Lesley; Overgaard, Shauna M; Ruben, Kerry; Wendicke, Annemarie. "Data Quality Management Model (2015 Update)" Journal of AHIMA 86, no.10 (October 2015): expanded web version.

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Data Reporting

� Workflow changes

� Need to improve data reporting and analysis

� Still using manual processes?

Future Opportunities

� Future

� Ambulatory CDI

� What documentation are we capturing and how?

� Combine with CDI in general?

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Things to Do Now

� Educate

� Estimate your MIPS score (tools coming)

� Optimize MU & PQRS/VBM Quality to maximize MIPS score

� Evaluate staff, resources and org structure

� Check - E.H.R. – 2015 certification completed?

ABCs of MIPS for 5 19 16 - Topic: Overview of MACRA/MIPS NPRM – HITECH Answers

Questions and Discussion

Aurae Beidler, MHA, RHIA, CHC, CHPS

Associate Risk Manager – Samaritan Health Services

[email protected]

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Additional Resources� http://journal.ahima.org/2016/06/02/macra-mips-and-

advanced-apms-time-to-prepare/

� MACRA – HealthAffairs Briefing 6/30/16

� https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Quality-Payment-Program.html

� AHIMA. "Data Quality Management Model (2012 update)" Journal of AHIMA 83, no.7 (July 2012): 62-71.

� Davoudi, Sion; Dooling, Julie A; Glondys, Barbara; Jones, Theresa D.; Kadlec, Lesley; Overgaard, Shauna M; Ruben, Kerry; Wendicke, Annemarie. "Data Quality Management Model (2015 Update)" Journal of AHIMA 86, no.10 (October 2015): expanded web version.

� https://blog.cms.gov/2016/09/08/qualitypaymentprogram-pickyourpace/

macra-mania! the quality payment program and him · macra-mania! the quality payment program and...

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