49 national healthcare reform medicare access and

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49National Healthcare ReformMedicare Access and CHIP Reauthorization Act
50National Healthcare ReformMACRA – MIPS Scoring
The Merit-based Incentive Payment System (MIPS) consolidatesthree existing quality reporting programs, and create a plus addsa new programPhysician Quality Reporting System (PQRS)Value-based Payment Modifier (VBPM)Meaningful use (MU)Clinical practice improvement activities (CPIA)Payment SchedulePhysicians participating in MIPS will be eligible for positive or negativeMedicare payment adjustments. Information collected in 2017 will impactreimbursement in 2019.Eligible professionals will receive a positive, negative, or neutral paymentadjustment based on their composite score. The negative adjustment willbe capped at four percent in 2019, five percent in 2020, seven percent in2021 and nine percent in 2022.National Healthcare ReformMACRA – Merit-based Incentive Payment System51
Exemptions from MIPS include:Providers in their first year billing Medicare;Providers whose volume of Medicarepayments or patients fall below the threshold(not yet defined); andProviders who qualify for payment underAPMs with the associated bonuses exemptfrom MIPS.NOTE: MIPS does not apply to hospitals or facilitiesNational Healthcare ReformMACRA – Merit-based Incentive Payment System52
What are APMs?An innovative payment model expanded under the Center for Medicare &Medicaid Innovation (CMMI);A Medicare Shared Savings Program (MSSP) accountable careorganization (ACO);Medicare Health Care Quality Demonstration Program or Medicare AcuteCare Episode Demonstration Program; orAnother demonstration program required by federal law.Unlike MIPS, APMs offer increased potential for risks and rewardsEligible professionals will receivefive percent bonuses each yearfrom2019 to 2024. Participation in an APM will also excludeeligible professionals from MIPS and most EHR Meaningful Userequirements.This is CMS incentivizing providers to take RISKNational Healthcare ReformMACRA – Alternate Payment Models53
Requirements:Use of quality measures comparable to measures under MIPS;Use of a certified electronic health record (EHR) technology; andAssumes more than a “nominal financial risk” (which is undefined),ORis amedical homeexpanded under the CMMI.A physician receiving the designated percentage of Medicarepayments or patients through a qualified, eligible APM based on theabove requirements is considered a “qualifying participant” (QP).Qualifying APM Participant:Are not subject to MIPS2019–2024: Receive an annual 5% lump sum bonus payment2026–beyond: Receive higher fee schedule updateNational Healthcare ReformMACRA – Alternate Payment Models54
The framework situates existing and potential APMs into a series of categoriesAPM Framework55Aligning incentives to promote health
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Delivery SystemReformCMS/CMMI ModelsMedical Homes(Advanced PrimaryCare)

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