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CMS offers insights on MIPS, APMs in MACRA's payment reform

Young and Kay explain how to handle payment reform under MACRA and the law's mandate to rid Medicare cards of Social Security numbers.

Susan Morse, Managing Editor

Pierre Yong, director of Quality Measurement and Value-Based Incentives Group and Monica Kay, director, Division of Program Management spoke at HIMSS17 in Orlando on Monday.Pierre Yong, director of Quality Measurement and Value-Based Incentives Group and Monica Kay, director, Division of Program Management spoke at HIMSS17 in Orlando on Monday.

ORLANDO -- A large crowd filled a ballroom at the HIMSS Annual Conference & Exhibition on Monday to hear from the Centers for Medicare and Medicaid Services on how to handle payment reform under the Medicare Access and CHIP Reauthorization Act and the law's mandate to rid Medicare cards of Social Security numbers.

CMS has received feedback from thousands of clinicians and others who are about to implement the quality payment mandates of MACRA, according to Pierre Yong, director, Quality Measurement and Value-Based Incentives Group, Centers for Clinical Standards and Quality, Centers for CMS.

The payments will be made based on quality measurements either through merit-based incentive systems or an advanced alternative payment model.

APMs have more demands but can offer greater rewards in a 5 percent payment, Yong said.

CMS will offer more details in a session on the quality payment program at 10 a.m. Tuesday, in an 8:30 a.m. session Wednesday on quality and cost, and later that day at 11:30 a.m. on MIPS for small, rural clinicians.

[Also: CMS awards $100 million for MACRA quality payment program training]

MACRA reforms Part B Medicare payments to physicians. For quality payment measures under MACRA, the first performance period opened January 1 and closes December 31.

The easier of the two reporting tracks, the merit-based incentive system, combines three legacy programs.

Under MIPS, physicians can select six of about 300 quality measures to report. CMS wants at least one to be an outcome measure or high priority measure, and report for a minimum of 90 days to be eligible for maximum payment adjustment.

During the transition year of 2017, clinicians can potentially earn a positive payment adjustment under MIPS, if they report quality data about the care they provide and how they use technology in 2017, by the March 31, 2018 deadline.

MIPS payment in 2019 will be based on the 2017 data.

[Also: While most pledge participation, providers lack clear strategy for MACRA compliance]

MIPS is open to clinicians who are billing more than $30,000 a year in Medicare Part B and who see more than 100 Part B patients a year.CMS is allowing participants to pick their pace for MIPS, with some reporting for a partial year and others for the full year. Clinicians can submit on a quality measure or improvement activity or on advancing care information to avoid a negative downward adjustment in payment, Yong said.

APMs can earn the 5 percent incentive payment in 2019 for reporting care provided during the year through an alternative payment model.

APMs include the CMS Innovation Center model other than a Health Care Innovation Award, providers in Medicare Shared Savings Program, Demonstration under the Health Care Quality Demonstration Program and demonstrations required by federal law.

There are three criteria: certify EHR technology, have a medical home model, or a requirement for participants to bear more than nominal financial risk.

"We feel the APM has tremendous promise," Yong said. "We recognize most practitioners will probably start out in MIPS"

APMs have to meet increasing criteria that advance over time. In 2019, a practice must see 35 percent of patients through alternative payment models, compared to 20 percent in 2017.

While the Trump administration is currently considering an overhaul of healthcare from the Affordable Care Act, to Medicare and Medicaid, experts believe MACRA is here to stay for the foreseeable future, as it received overwhelmingly bipartisan support.

MACRA law also mandated the removal of the social security number-based Health Insurance Claim Number from Medicare cards due to the privacy breach risk.

[Also: Nearly 85% of independent physicians unsure of MACRA requirements, but look to participate]

The transition period is April 1, 2018 to Dec. 31, 2019. CMS will issue new Medicare cards to 60 million beneficiaries. The cards will not have the letters

SLOIBZ to avoid confusion of numbers and letters, according to

Monica Kay, director, Division of Program Management, Office of Enterprise Information, for CMS.

Yong said CMS has seen impressive results in value-based efforts, from a 17 percent reduction in hospital acquired conditions across all measures from 2010 to 2013, to savings of $37 million from providers participating in the advanced ACO Pioneer program.

"We at CMS feel that delivery system reform is really important," Yong said.

Twitter: @SusanJMorse

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