Thought Leadership Webinar: Exploring the MIPS Quality Measure

It’s been well over a year since MACRA of 2015 was passed by Congress and signed into law but according to according to Deloitte’s 2016 Survey of U.S. Physicians, only about 50 percent of practicing physicians have heard of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Interestingly of those 50 percent who have heard of MACRA, the majority have only heard about it but really know nothing about what it is and how it will affect them. We have created a MACRA webinar series to serve as a valuable resource to help your organization prepare now for MACRA.

This webinar is the fourth in our MACRA Webinar Series. Previous webinars include:

•The 411 on Value-Based Reimbursement
•Connecting the dots between PQRS, MIPS, & CAHPS
•MACRA under the lens of a clinically integrated network

In this webinar, Moshe Starkman explores the ins and outs of the MIPS Quality Performance Category. The Quality category accounts for 50 percent of your MIPS composite score in 2017 so there’s no time like the present to begin preparing.  In this webinar, Moshe explores:

  1. The differences between PQRS 2016 and MIPS 2017
  2. How scoring is done within the Quality category
  3. How the Quality score impacts the MIPS Composite Performance Score
  4. Considerations to ensure that you’re getting ready for MACRA

If you’d like to learn more about how we can assist you with your MACRA readiness or how our MIPS Composite Performance Score projection and monitoring tools can help you in the long term, please contact Moshe directly at or 801.783.4100.


Thought Leadership Webinar: MACRA under the lens of a Clinically Integrated Network

MACRA is extremely complex and ever evolving — and even though the MACRA guidelines will not be finalized until October 2016 — you really shouldn’t wait until then to begin learning and thinking about the strategic implications for your health care system.

It is our hope that through our MACRA webinar series, you will gain the insight and perspective that will enable you to think deeply and effectively as you prepare for the MACRA changes ahead.

In the third webinar of the series, we welcome Tyler Wilson of Catholic Health Initiatives (CHI) as a panelist. CHI is a nonprofit, faith-based health system operating 105 hospitals in 18 states, and 12 Clinically Integrated Networks (CINs). As the National Director of Clinically Integrated Network Development & Integrity, Tyler supports the development and operations of CHI’s 12 Clinically Integrated Networks (CINs). He is passionate about value-based care delivery and the pursuit of population health as a viable strategy for the future.

In this webinar, we discuss shared savings implementation and risk management as it pertains to the recently passed MACRA legislation.

Learning Objectives:

  • What we know about MACRA (as of June 2015)
  • CHI and Clinically Integrated Networks (CINs)
  • CINs as they pertain to MIPS and/or qualifying as an Advanced APM
  • Understanding MACRA preparedness efforts through the lens of Clinically Integrated Networks
  • MIPS or MIPS + AAPM? If AAPM, which one and how do we decide?
  • How do we prepare for MIPS?


Thought Leadership Webinar: What is GPRO and CAHPS?

Understanding how to navigate the new CMS value-based reimbursement reporting guidelines and regulations can be tricky, but certainly not impossible.

In this second session of our educational webinar series addressing value-based reimbursement, we explore group reporting options (GPRO), review the Consumer Assessment of Healthcare Providers and Systems (CAHPS) and examine its requirements, patient eligibility, & survey implementation.

So what exactly is GPRO and CAHPS?
Group practices with two or more eligible clinicians (ECs) can register with CMS to report PQRS data through the group practice reporting option (GPRO). These group practices must have grouped their National Provider Identifiers (NPI) under a single Taxpayer Identification Number (TIN) umbrella to be eligible. So, if your practice, hospital, and/or health network represents two or more eligible clinicians that bill under the same TIN then you’re eligible for group reporting.

CAHPS includes consumer and patient surveys that ask them to report on and evaluate their healthcare experiences. CAHPS surveys are not customer service surveys. Instead, the survey’s cover topics that are important to consumers, focusing on those aspects of quality consumers are best qualified to evaluate.

If your group practice registers for PQRS by the June 30th deadline and consists of between 2 and 99 ECs, then you may elect to include CAHPS for PQRS as part of your PQRS submission. If your group practice consists of 100 or more eligible clinicians (ECs) then it is actually required.

To learn more, watch the video below.

Thought Leadership Webinar: The 411 on MIPS

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.


Nailing PQRS in 2016 is the Best Way to Prepare for MIPS

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:

Screen Shot 2016-04-30 at 1.04.20 AM


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