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MACRA
(Medicare Access & CHIP Reauthorization Act)

In November 2015, The Centers for Medicare & Medicaid Services (CMS) released the final rule for MACRA, altering how Medicare reimburses clinicians and their practices. It emphasizes quality, value, and clinicians taking more financial risk.

TSI Healthcare® is here to help you navigate through the murky waters of federal regulations.

Be sure to check out our other resources:

[sf_button colour=”accent” type=”standard” size=”standard” link=”https://tsihealthcare.com/guide-request-mips-2021/” target=”_blank” icon=”ss-desktop” dropshadow=”no” extraclass=””]Download our MIPS 2021 Guide[/sf_button] [sf_button colour=”accent” type=”standard” size=”standard” link=”https://tsihealthcare.com/brochure-request-quality-program-services/” target=”_blank” icon=”” dropshadow=”no” extraclass=””]Download Brochure [/sf_button]

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What’s The Big Idea?

With a stronger emphasis on quality, value, and bigger financial risk, there are three key areas MACRA seeks to address.

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Repeals SGR

Sustainable Growth Rate

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Shifts from Volume to Quality

Shift from fee-for-service
to pay-for-quality

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Extends CHIP

Children’s Health
Insurance Program

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Congratulations to TSI Healthcare Small Practices!

In 2019, 100% of clients using our Quality Program Services received the exceptional performer bonus.

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MIPS penalties/incentives are calculated based on a 2-year look-back period

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Quality Payment Program

MACRA’s Quality Payment Program allows providers to choose between two participation tracks: MIPS or APMs.

 [sf_button colour=”accent” type=”standard” size=”standard” link=”https://tsihealthcare.com/guide-request-mips-2021/” target=”_self” icon=”ss-desktop” dropshadow=”no” extraclass=””]Download 2021 MIPS Guide[/sf_button]

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MIPS

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APMs

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• Combines Meaningful Use, PQRS/CQMs & Value-Based Modifier (VBM)
• Measures providers on:
  • Quality
  • Promoting Interoperability (Formerly ACI)(Use of EHR)
  • Improvement Activities
  • Cost
• Financial Implications
  • Can receive a negative or positive payment adjustment based on MIPS Composite Score
  • Can receive up to 9% max penalty for not meeting 2021 MIPS requirements

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• Measures providers on:
  • APM specific goals, similar to MIPS with a few additions & exceptions
• Financial Implications:
  • APMs can receive incentive payments for providing high-quality & cost-efficient care
  • Advanced APMs bear financial risk & can earn a 5% bonus

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Timeline

MIPS will continue in 2021 as the 5th performance year. Payment adjustments received in 2021 are based on 2019 performance.

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MIPS Year 5 Program Overview

The new quality program structure increases emphasis on interoperability and quality, while decreasing patient costs.

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[sf_modal header=”Quality” btn_colour=”accent” btn_type=”standard” btn_size=”standard” btn_text=”Learn More”]

• Focus: Clinical Quality
• Report 6 measures
• Emphasis On: Outcomes 
• New: 70% data completeness

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[sf_modal header=”Resource Use/Cost” btn_colour=”accent” btn_type=”standard” btn_size=”standard” btn_text=”Learn More”]

• Focus: Reducing unnecessary spending via preventative & outcome focused care
• Calculated from Medicare claims
• New: telehealth virtual visits included in calculations for the Total Per Capita Cost (TPCC) and episode-based cost measures

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[sf_modal header=”Promoting Interoperability” btn_colour=”accent” btn_type=”standard” btn_size=”standard” btn_text=”Learn More”]

• Focus: Use of Technology
• Report 4 objectives & complete a security risk analysis
• New: Query of Prescription Drug Monitoring Program (PDMP) measure will be worth 10 bonus points
• New: option to report the two existing Health Information Exchange (HIE) measures OR attest to the new HIE Bi-Directional Exchange measure

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[sf_modal header=”Improvement Activities” btn_colour=”accent” btn_type=”standard” btn_size=”standard” btn_text=”Learn More”]

• Focus: Care coordination, beneficiary engagement, and patient safety
• 100+ available options
• New: COVID-19 clinical trials high-weighted improvement activity
• New: option to report the two existing Health Information Exchange (HIE) measures OR attest to the new HIE Bi-Directional Exchange measure

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Introducing Quality Program Services

Overwhelmed by MACRA and MIPS? Stress no more!
TSI Healthcare’s revolutionary new approach to federal policy assistance provides you with the next level of
regulatory assistance and client advocacy.

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[sf_button colour=”accent” type=”standard” size=”standard” link=”https://tsihealthcare.com/brochure-request-quality-program-services/” target=”_blank” icon=”” dropshadow=”no” extraclass=””]Download Brochure [/sf_button]

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An online resource center to help practices navigate the new MIPS requirements.

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Workflow “how-to” videos for easy learning on the fly for role-specific and specialty-specific measures.

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Guided assistance with hands-on regulatory training from a Quality Program Specialist allows you to focus on patient care.

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