MACRA and MIPS Update: 2018 A Transitional Year Geraldine McGinty MD MBA FACR* Vice Chair ACR Board of Chancellors *with full credit to Dr Zeke Silva
Agenda for today What a difference a year makes! How the Quality Payment Program (QPP) is being implemented for radiologists Strategies for successful participation in QPP Where to find resources about the QPP
ACA Repeal Process: An Exhausting Rollercoaster March 7, 2017: Republicans introduce the first version of the AHCA in the House March 8, 2017: Committees approve the AHCA and move it to the floor March 24, 2017: AHCA version 1 fails to be put to a vote April 20, 2017: Second draft of the AHCA released, includes the Upton and MacArthur amendments May 4, 2017: House passes bill 217-213, vote falling on party lines June 23, 2017: Senate releases draft of the Better Reconciliation Care Act July 25, 2017: Senate vote to pass Better Care Reconciliation Act fails July 28, 2017: Senate vote to pass Skinny repeal bill fails September 26, 2017: Majority Leader Mitch McConnell pulls Graham-Cassidy after third Senate Republican comes out against the bill September 30, 2017: Reconciliation expires, thus killing ACA repeal for remainder of 2017 December 20th, 2017: Congress passes a tax reform bill which includes repeal of the PPACA s Individual Mandate to purchase health insurance
Where are we in February 2018? ACA is still law albeit with mandate repealed Alexander-Murray on hold but may be linked to spending bill No Bare Counties although coverage varies and premium increases are steep with some anomalies Robust sign up during curtailed open enrollment period for exchanges Secretary Price successor confirmed 5
Leading CMS: Seema Verma MPH from Hopkins Medicaid policy consultant Supports cost sharing and work/service requirements for Medicaid promoting personal responsibility while providing subsidized health protection to those who can least afford it. #
Dr. Price s legacy Joint bundle no longer mandatory Cardiovascular care bundles cancelled MACRA marches on but with increased latitude Experimenting with Americans health Rep Tom Price in a letter to CMS #
Is this still even relevant? 8
9 ACR ECON UPDATE MIPS VVP
Growth in utilization of Medicare physician services 7% 6% 5% 4% 3% 2% 1% 0% -1% 1997 1999 2001 2003 2005 2007 2009 2011 2013 2015 10 2017 American Medical Association. All rights reserved.
Breaking news!
Dartmouth/Yale Worked at HHS for Pres. George W Bush Former Eli Lilly Executive 12
SECTION 1. SHORT TITLE; TABLE OF CONTENTS. (a) SHORT TITLE. This Act may be cited as the Medicare Access and CHIP Reauthorization Act of 2015. (a) STABILIZING FEE UPDATES.- (1) REPEAL OF SGR PAYMENT METHODOLOGY.-SECTION 1848 (b) CONSOLIDATION OFCERTAIN CURRENT LAW PERFORMANCE PROGRAMS WITH NEW MERIT-BASED INCENTIVE PAYMENT SYSTEM.
Quality Payment Program MACRA QPP MIPS APMs ADVANCED APMs 15
What MIPS is made of Now (2016-2018) Future (2019- ) 1. Physician Quality Reporting System 1. Quality 2. Value Modifier 2. Cost 3. Meaningful Use + 3. Advancing Care Information 4. Clinical Practice Improvement Activities Initially 4% of payment at risk Up to 9% when fully implemented
ACR ECON UPDATE 2017 2018 Transitional Years
ACR ECON UPDATE 18 2017 2018Final Score: Around 4% 5% in play Max Negative Zero Adjustment Positive Adjustment Max Adjustment 0 3 15 100 Performance Threshold
19 ACR ECON UPDATE Weighting of MIPS Factors 2018 Performance Period QUALITY COST 50pts ADVANCING CARE 15pts INFORMATION IMPROVEMENT ACTIVITIES 10pts 25pts
20 Cost It s Here! Quality Was 90 days, now up to full year; Data completeness Now 60% Patient Facing vs. Non-patient Facing New Patient Encounter Codes ACR ECON UPDATE
21 patient facing INDIVIDUAL Bill more than 100 Patient Facing Encounters per year GROUP More than 25% of individuals are Patient Facing ACR ECON UPDATE / WINTER 2018
22 Patient Facing Codes - 2018 CMS removed from the list Paracentesis Thoracentesis Joint injections Lumbar puncture Myelography ACR ECON UPDATE
23 ACR ECON UPDATE Weighting of MIPS Factors Non-patient facing 2018 Performance Period QUALITY 75pts COST 10pts 15pts IMPROVEMENT ACTIVITIES
24 ACR ECON UPDATE Small & Rural Practice Fewer than 15 physicians More quality points Extra bonus at the end
Beyond the $ Documenting our quality will be critical 25
Who are my MIPS Champions? Dr Ezekiel ( Zeke ) Silva Chair, Economics Commission Dr Gregory Nicola Chair, MACRA Committee
ACR is your QPP Champion
A dedicated group of volunteers and staff Gregory Nicola, MD, FACR Ezequiel Silva III, MD, FACR Linda A Wilgus Eric Matthew Rubin, MD Daniel A Finelli, MD, FACR Naveen Parti, MD, FACR David J Seidenwurm, MD, FACR Richard Heller, MD Bibb Allen JR, MD, FACR Ryan Lee, MBA, MD Robert Barr, MD, FACR Andrew B Rosenkrantz, MD William D Donovan, MD, MPH, FACR Alena V Kreychman, MD Joshua A Hirsch, MD, FACR Lauren Parks Golding, MD Dana H Smetherman, MD, FACR Kurt A Schoppe, MD Jay R Parikh, MD, FACR Nicole Saphier, MD Ashima Lall, MBA, MD Dominick Parris, Pam Kassing, Judy Burleson
A word about metrics.. ACR members work on developing them Judy Burleson ACR Staff Collaboration and trust with CMS essential Always striving for more outcomes Accurate Diagnosis is an outcome Think we need better measures? Volunteer! Chair: David Seidenwurm, MD Alexander Towbin, MD Ammar Sarwar, MD Ari Blitz, MD Benjamin Franc, MD Cindy Lee, MD Greg Nicola, MD Jason Itri, MD Jennifer Broder, MD Jenny Hoang, MBBS Jonathan Kruskal, MD Kesav Raghavan, MD Marta Heilbrun, MD Matt Hawkins, MD Samir Patel, MD Steven Baccei, MD On our measure Technical Expert Panel we also currently have included several
33 Seema Verma, CMS Administrator we all believe that quality metrics need to be based on real outcomes instead of processes 2017 LAN Fall Summit, Arlington, VA, 11/3/17 ACR ECON UPDATE
So how do I succeed? Who is buddies with the hospital CIO?
Radiologists do it better? Tech savvy Changing our culture Need to document our value Preserving access to preventive screening Expanding that access Creating an improvement infrastructure Creating value for our patients