Is Your Hospital Ready For MACRA?

Starting in 2017, your hospital’s clinical staff will be evaluated by Medicare through a new system mandated under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) called the “Quality Payment Program”. Under this system, your hospital has two options:

Advanced Alternative Payment Models (APMs)

Include MSSP ACOs in Tracks 2 & 3 and Next Generation ACOs

The Merit-Based Incentive Payment Systems (MIPS)

Everybody else will be subject to MIPS

PQRS 2016 – Get Ready For MACRA

Under MIPS, a large (up to 16% in 2017 and growing each year thereafter) of your clinicians’ Medicare Part B reimbursement will depend on your performance. In 2017, clinical quality makes up 50% of your clinicians’ performance score. Don’t wait till the end of the year to measure and report … Leverage the last year of PQRS to ensure that your hospital maximizes Medicare Part B reimbursement… Clinigence offers PQRS 2016 reporting that ensures your hospital will be ready for MIPS or any MACRA model for years to come!

Leverage Fee-For-Service Opportunities

Many activities promoted under value-based payment are also reimbursable under current fee-for-service (FFS) models. Since value-based models, such as shared savings, often offer only deferred reimbursement, you may find it especially beneficial to leverage any opportunity to increase revenue in the short-term while building your capacity to take on risk and deliver value in the future. Among these opportunities:

  • Annual Wellness Visits (AWVs)

  • Chronic Care Management (CCM)

  • Closing Gaps in Care

  • Comprehensive Primary Care Plus (CPC+)

  • Preventing Network “Leakage”

In all of the above, Clinigence identifies and intelligently stratifies your patients in need of service – ensuring they get better care while you secure the associated add-on revenue.

Advanced Alternative Payment Models (APMs)

If you are already participating in a Track 2 or 3 Medicare Shared Savings (MSSP) ACO or a Next Generation ACO, or if you are considering participation in either of these models in 2017, follow this link to read about our solutions for ACOs and Risk-based Delivery Organizations.

The Merit-Based Incentive Payment System (MIPS)

The Merit-based Incentive Payment System (MIPS) combines the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) incentive program into a single program. Your clinicians’  2017 performance can impact your Medicare Part B reimbursement by up to 16% and growing each year after that.  Your MIPS score will be based on your performance in 4 areas:

  • Quality (50% in 2017)

  • Resource Use (10%)

  • Clinical Practice Improvement (15%)

  • Meaningful Use of Certified EHR Technology (25%)

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