Let CareVitality’s team help you successfully transform your practice to these new cost and quality initiatives in the Quality Payment Program (QPP).

Practice Transformation

MACRA (Medicare Access and CHIP Reauthorization Act of 2015) is bipartisan federal legislation signed into law on April 16, 2015. MACRA repeals the SGR Formula that determined Medicare Part B reimbursement rates for physicians and replaces it with new ways of paying for care for many physicians.

Under MACRA, participating providers will have an increasing percentage of Medicare payments based on the quality and effectiveness of the care they provide (value focused) rather than the volume of patients as in traditional fee-for-service.

High value care (termed as value-based care) will be defined by measures of quality and efficiency. Providers will earn more or less depending on their performance against those measures.

MACRA’s Quality Payment Program (QPP) establishes two payment tracks:

  • Advanced Alternative Payment Models (Advanced APMs)
  • Merit-Based Incentive Payment System (MIPS)

The proposed rule narrowly defines Advanced APMs as downside risk-bearing models such as Medicare Shared Savings Program Track 2 and Track 3, leaving the vast majority of eligible clinicians subject to MIPS.

Under MIPS, eligible clinicians will receive a composite performance score based on the following:

  • Quality 
  • Cost/Resource utilization (0% of score in 2017, increasing to 30% in future years)
  • Advancing Care Information 
  • Clinical Practice Improvement 

Eligible clinicians will be scored and ranked against each other nationally, and scores will be publicly available.

Clinician scores during calendar year 2017 will determine payment adjustments in 2019.

MIPS is required to be budget neutral, and the payment bonuses and penalties progressively increase each year as illustrated in the graph below.

MIPS chart

MIPS Consulting and Implementation

Category

Requirements

How CareVitality Can Assist Your Practice or Organization

Quality

Replaces the Physician Quality Reporting System (PQRS)

Most Participants: Report up to six (6) quality measures including an outcome measure.

Groups using the web interface: Report 15 quality measures for a full year.

Groups in APMs qualifying for special scoring under MIPS, such as Shared Savings Program Track 1 or the Oncology care Model: Report quality measures through your APM. You do not need to do anything additional for MIPs quality.

CareVitality, Inc., subsidiary of EHR & Practice Management Consultants, Inc., has been assisting healthcare organizations adopt, utilize and optimize technology in order for their practice(s) to implement and participate in Meaningful Use, PQRS, ICD-10, Health Information Exchanges and Patient Portals, etc. We are now providing the same experience and comprehensive services to assist healthcare organizations and practices to help them transition into MACRA, MIPS and APM.

We can help you determine which quality measures you report, the outcome and the duration for any size practice or APM.

Additionally, we can help you customize your existing system and provide additional training when needed to help you properly document the measures needed to properly report for the Quality Payment Program (QPP) you are participating in.

Category

Requirements

How CareVitality Can Assist Your Practice or Organization

Improvement Activities

New category

Most Participants: Attest that you completed up to 4 improvement activities for a minimum of 90 days.

For small practices, rural practices, or practices located in geographic health professional shortage areas (HPSAs), and non-patient facing MIPS eligible clinicians: Attest that you completed up to 2 activities for a minimum of 90 days.

Participants in certified patient-centered medical homes, comparable specialty practices, or an APM designated as a Medical Home Model: You will automatically earn full credit.

Participants in certain APMs under the APM scoring standard, such as Shared Savings Program Track 1 or the Oncology care Model: You will automatically receive points based on the requirements of participating in the APM. For all current APMs under the APM scoring standard, this assigned score will be full credit. For all future APMs under the APM scoring standard, the assigned score will beat least half credit.

CareVitality, Inc. has been assisting practices with Training, System Customization/ Optimization and Attestation since the onset of Meaningful Use.  Additionally, CareVitality, Inc. provides service offerings for Chronic Care Management, Transitional Care Management, Annual Wellness Visits as well has a Patient Engagement Center to assist clients to be in successful in participating in the Quality Payment Program/ MACRA.

CareVitality’s in depth audit experience will help providers save the proper documentation prior to your Quality Payment Program attestation.

If you are worried you are not compliant, we can provide an assessment to identify any gaps, assist in mitigation prior to an audit and assist with the entire attestation process.

Category

Requirements

How CareVitality Can Assist Your Practice or Organization

Advancing Care Information

Replaces the Medicare EHR incentive Program, also known as Meaningful Use.

Full Participation in MIPS fulfill the required measures for a minimum of 90 days:

  • Security Risk Analysis
  • e-Prescribing
  • Provide Patient Access
  • Send Summary of Care
  • Request/Accept Summary of Care

Choose to submit up to 9 measures for a minimum of 90 days for additional credit.

For bonus credit, you can:

  • Report Public Health and Clinical Data Registry Reporting measures
  • Use certified EHR technology to complete certain improvement activities in the improvement activities performance category

OR

You may not need to submit advancing care information if these measures do not apply to you.

Security Risk Analysis

CareVitality can perform your Security Risk Analysis. A risk analysis is required to determine the threats and vulnerabilities to your protected health information. We use a proven method to review, document your risks, and to develop a detailed HIPAA Privacy & Security Risk Analysis and Mitigation Plan which we can assist you in your mitigation efforts and meet the Advancing Care information requirement.

e-Prescribing

CareVitality provides implementation and training support for e-prescribing.

Provide Patient Access

CareVitality can help your practice or healthcare organization allow for your patients to easily access their health information, via eHealth tools such as a Patient Portal. Let our expert consultants help your practice or healthcare organization with patient engagement and patient access to empower your patients to be more in control of decisions regarding their health and well-being.

Send Summary of Care Request/Accept

CareVitality can train providers on how to share health information securely and timely. By sharing patient health information like a patient’s Summary of Care, it allows healthcare providers and patients to appropriately access and securely share a patient’s vital medical information electronically thereby improving the speed, quality, safety and cost of patient care.

Bonus Credit

CareVitality has been assisting practices and healthcare organizations submit to registries since the onset of PORS. Let our expert consultants assist you as an eligible provider (EP), eligible hospital (EH), or critical access hospital (CAH) actively engage with a public health agency to submit electronic public health data from your certified electronic health record technology (CEHRT) and receive a Quality Payment Program bonus.

Utilize CareVitality’s expert consultants to assist your practice in implementing the Quality Payment Program.

In order for providers to optimize payments under Advanced APMs and MIPS, eligible clinicians should focus their efforts on these three (3) areas immediately:

Annual Wellness Visit Programs

The Annual Wellness Visit (AWV) is a benefit to all patients to have the preventive and wellness care they need to stay healthy and lead productive lives.

AWVs are especially important in the elderly and those with disabilities by promoting health awareness and improved patient outcomes by collecting health, social and functional information that can be used for early detection and/or prevention.

Learn more by going to our Annual Wellness Visit page.

Chronic Care Management Program

The importance of proactive and frequent care management of patients with multiple chronic conditions is an important component under MACRA.

An effective way to address these at-risk patients is by participating in the CCM program (CPT 99490), which provides monthly non-face-to-face clinical support between office visits for patients with two or more chronic conditions.

Providers are now being incentivized to provide the necessary infrastructure and resources to be successful under MACRA and promoting preventive care management to the patients who need it the most.

Learn more by going to our Chronic Care Management page.

Transitional Care Management

As part of the Hospital Readmission Reduction Program (HRRP) there was a need to incentivize providers for taking actions to provide the much-needed care to at risk and vulnerable Medicare patients upon discharge from an acute setting and to hopefully prevent readmission or re-hospitalization.

Providers are  being incentivized to provide the necessary infrastructure and resources to help patients from being readmitted.  

Learn more by going to our Transitional Care Management page.

Contact Us Today to Learn How We Can Successfully Assist You in Participating in the Quality Payment Program (QPP)