In April 2015, Congress addressed and ended the highly unpopular SGR Fee-For-Service Medicare reimbursement model in favor of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).
MACRA moves healthcare away from a fee-for-service mindset towards a value-based care mindset where high-quality care at a reduced cost is rewarded.
Over the course of this year, we will be hosting a series of webinars to help you understand how to navigate MACRA and how to prepare for the changes.
In this webinar session, Moshe Starkman, Equation Senior Consultant and Product Specialist, discusses:
- The creation of the Merit-Based Incentive Payment System (MIPs) including the four components of the MIPS composite performance score.
- The differences between PQRS and Quality component of the MIPS CPS.
- The proposed Medicare reimbursement bonus and penalty schedule.
Fill out the form below to watch the webinar.
Does MACRA (Medicare Access or CHIP Authorization Act) or MIPS (Merit-based Incentive Payment System) sound daunting? If you’re like most health systems you’ll answer with a gulping yes.
Before I answer your question about the best way to prepare for MIPS, let’s just make sure we are on the same page by answering the following:
What exactly is MIPS?
Starting CY2017, MIPS will annually measure Medicare Part B providers in four performance categories to derive a “MIPS score” (0 to 100), which can significantly change a provider’s Medicare reimbursement in each payment year. The performance categories and point allocations for the CY2017 performance year are 50 points for quality (PQRS/VBM), 25 points for meaningful use, 15 points for clinical practice improvement, and 10 points for resource use.
The MIPS final rule (due late this year) will determine how points are earned within each component.
The financial impacts of the MIPS scoring system can be significant. The following diagram shows how it works:
Each performance year (say 2017, corresponding to the Payment Year 2019 in the diagram above), CMS sets a “performance threshold” (PT) number of points at which a provider earning PT points receives 0% adjustment to their Medicare Part B payments.
If PT = 50, then only a provider earning exactly 50 points will get 0% payment adjustment. A provider earning 51 points earns an incentive, whereas one achieving only 49 points will be assessed a penalty. These payment adjustments increase in size linearly as the point value further deviates from the PT value of 50 until maximum incentives are penalties are reached.
Furthermore, as can be seen in the diagram, the maximum base payment adjustment can range up to a 9% x 3.0 = 27% incentive or down to a -9% penalty.
Medicare is able to reward winners so much more than losers because the entire MIPS program is designed to be budget neutral, whereby the national incentive pool is set equal to the national penalties applies. Since there are anticipated to be more losers than winners, winners can reap substantial financial rewards under MIPS.
The performance threshold PT is determined annually as the mean or median of the MIPS scores for all EPs in a prior period as selected by CMS. For the initial two payment years (2019 and 2020), the PT will not be based on historical MIPS scores but rather on a combination of historical performance on measures and activities related to PQRS, MU, VBM, and possibly other factors as determined by CMS.
Now there is some additional nuance that isn’t covered above, such as alternate payment models. In the coming weeks we’ll detail all fo the nuance and diagram the most optimal path to take. Now on to the pressing question:
How can I prepare now for MIPS?
Nail PQRS today with a monitoring model. Some readers may be reading this and saying to themselves, “well, this seems simple.” All I need to do is nail PQRS, I have been doing that for years now.” But, have you been monitoring and trending it in such a way where you know how things are progressing at any given point? MIPS is very much focused on improvement and if you’re not monitoring PQRS for improvement now, how will you do it when you have many different clinical improvement measure that need to be tracked? If you couldn’t read into where CMS is trying to take MIPS then let me say it simply — MIPS is the beginning of the era of improving quality measures while also lowering the cost of healthcare (two of the three triple aims).
Equation’s PQRS Offering
Sound daunting? It shouldn’t be, not if you have Equation helping you. In the coming weeks Equation will be releasing more details about how it will help health systems nail MIPS. A major part of preparing for MIPS is utilizing Equation to calculate PQRS measures now and then to utilize that data to begin tracking progress towards hitting MIPS. Keep your ear to this blog because we will announce soon in greater detail how we can help you best prepare for MIPS.
If you are interested to have Equation calculate and submit PQRS measures then please reach out to Mike Romney at 801.783.4100 or email him at email@example.com.
We’re extremely excited to introduce a new update to the DataRiver platform. This past fall, we took a hard look at the platform and how users were interacting with it. With that and additional feedback from all of you, we were able to identify gaps and began building behind the scenes with a brand new focus on not only resolving these gaps but rethinking how we approach building new products on the platform.
So let’s get into it…
Leading with a Mobile-First Methodology.
The driving methodology for this update was centered on mobile use. We know you want to access the operational and economic insights in DataRiver when you need them, which is not always when you’re at your desk.
We’re excited to announce that we’ve rebuilt the platform around a mobile-first methodology.
Mobile first strategies build to the constraints of mobile devices, and the needs of mobile users first.
This methodology allows for an unprecedented level of intentionality across every product that you use to improve economic and operational outcomes for your organization. Here’s how:
- Right Platform. Right Data. Right Time. When most companies offer mobile experiences, especially in analytics, they limit features on mobile. We knew this wasn’t an option. We’ve built a consistent, full-featured experience across any device. Regardless of iOS, Android, Windows, or desktop you are able to perform that same analysis and get the insights you need exactly at the time you need them. By giving access to the right data at the right time on any device, you can actually do your job and start improving outcomes.
- Signal vs. Noise. Losing 80% of the screen space on mobile devices forces the platform to focus. We needed to make sure what stayed on the screen was the most important set of features. This eliminates noise that often gets in the way of surfacing insights and enabling you to make decisions.
- Faster Processing. When it comes to mobile networks, inconsistency in speed is a major factor facing big data analytics platforms like DataRiver. Because of this mobile-first methodology, rebuilding the platform to perform 10x faster and more efficiently was a must. I’m excited to say we’ve done just that.
If you would like to learn more about our reasoning behind our new methodology you can review a recorded webinar here.
So What’s New?
We’ve stripped away and introduced new elements to the DataDock, DataRiver’s home page. You can easily jump into any of the Analyzer products and access DataPoints or any of our recent webinars. This redesign has also set us up to bring intelligent notifications to the DataDock alerting you to critical insights and actions in your organization.
This is by far our most widely used product on the platform so we knew we had to get it right. You’ll notice a deep focus on surfacing insights by lowering the time to digest individual metric performance. Creating and editing dashboards is as easy as a single tap with sharing, exporting, and launching research pivots available in an elegant right-panel menu.
Service Line Analyzer
Analyzing the performance of individual service lines is critical to your organization and we’ve brought a full-featured experience to any device. You can easily drill-into service lines, view trends through beautiful visualizations, and get the answers you need much faster and more convenient than ever before. And yes, even drill-down to the DRG level.
This update not only brings Downstream Analyzer to every device but also brings a brand-new way to get into the data and get the answers you need. You can now group your downstream tracking programs into segmented categories to perform analysis, visualize downstream margin by encounters, and view individual performance.
A10 Practice Assessment
Equation has always been known for our A10 Practice Assessment and we’re excited to now introduce this product and it’s value into the hands of every DataRiver user, on any device. We analyze all of your data, split it across ten economic drivers, and give detailed analysis on opportunity across your organization. The first two drivers are available which focus on Productivity and Coding. This gives you visibility into opportunity and allows you to drill-down to the provider level.
And so much more.
We’re excited for you to experience all that we’ve accomplished in this release. More so, we’re excited for the impact DataRiver will have in your organization. The opportunity to make data-driven decisions has never been so great.
Available Monday, May 2nd… Everywhere.
We’re excited to have a live Twitter stream of today’s Equation Day. We’ll be talking about the future of DataRiver and analytics in healthcare. Feel free to use the #EquationDay hashtag to interact.