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MIPS v, APMS
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MIPS and APM
Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act
- Established in 2015 in response to the repeal of the sustainable growth rate formula
- Under this law the Centers for Medicare & Medicaid Services implemented a new payment mechanism to replace the SGR, known as the Quality Payment Program
- Through the QPP Merit-based Incentive Payment System(MIPS) was created and emphasis was placed on Alternative Payment Models(APMs)
MACRA
Merit-based Incentive Payment System
Providers who meet this criteria are exempt from MIPS
Physician quality reporting system
Value Based Payment Modifier
Electronic Health
Record
MIPS
ECUP will see a 1.79% incentive for all of the Medicare patients we will see in 2019.
ECUP/VMG score is a 95.8% quality score under the new Medicare Quality system (MIPS)
Alternative Payment Models
- APMs provide a model for paying physicians that differs from the traditional fee-for-service construct. The goal of APMs is to improve the quality and value of care provided, reduce growth in health care spending, or both.
- CMS describes APMs as payment models that create incentives for clinicians to provide high-quality, cost-efficient care for a specific clinical condition, episode of care, or population.
APM
MIPS-APM
- CMS created a separate scoring standard in the Merit-based Incentive Payment System (MIPS) for certain APMs to avoid duplicative data reporting requirements for MIPS-eligible clinicians.
- The models to which this scoring standard applies are referred to as MIPS APMs.
MIPS-APM
Advanced-APM
CMS has approved the following A-APMs for the 2017 performance year:
- Comprehensive End-Stage Renal Disease Care—Two-Sided Risk
- Comprehensive Primary Care Plus
- Next Generation Accountable Care Organizations
- Medicare Shared Savings Program Tracks 2 and 3 (Vidant Health)
- Oncology Care Model—Two-Sided Risk
- Comprehensive Care for Joint Replacement Payment Model Track 1 with CEHRT requirements
A-APM
ACS-Brandeis A-APM
- A-APM developed by ACS and Brandesis University
- Episode Grouper for Medicare to group Medicare claims into episodes of care
- PTAC approved the APM at its April 2017 meeting
- The PTAC sent its formal recommendation to HHS Secretary
ACS-Brandeis A-APM
- Vidant Health and ECU participate in Medicare Shared Savings Program
- Vidant Health and ECU Physicians, the faculty practice of ECU’s Brody School of Medicine – saved Medicare more than $8.9 million last year on the health care provided to their 24,574 assigned beneficiaries.
- ECU Physicians and Vidant Health received 44.6 percent of the savings they generated, or $3.9 million, as a performance payment.
Example
- Changes the reimbursement through reporting and quality
- Penalties for not participating or meeting designated thresholds
- Where to hang your hat?
Relevance
- “Alternative Payment Models.” The Bulletin, 31 Aug. 2017, bulletin.facs.org/2017/09/alternative-payment-models/.
- “Modernizing Medicare to Provide Better Care and Smarter Spending for a Healthier America.” Alternative Payment Models (APMs) Overview - QPP, qpp.cms.gov/.
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