MARCH 24, Tale of the Tape: MIPS vs Medicare ACO

Transcription

1 MARCH 24, 2016 Tale of the Tape: MIPS vs Medicare ACO

2 About Tom Lee, Ph.D. Founder & CEO of SA Ignite Tom is a technology innovator and leader who brings his unique world view and compassion to create health IT solutions for the business of caring for people. He is the father of two small children and after a frightening personal experience, it was his concern for their future in the world that inspired him to create a company that matched his personal passion: driving innovation in the public healthcare system. Contact him at: tom@saignite.com WEBINAR SERIES BROUGHT TO YOU BY: HITECHANSWERS.NET AND SAIGNITE.COM

3 Key Takeaways From The February Webinar MIPS for the C-Suite #1 Fact: Winners rewarded at expense of losers (budget-neutral) Elevator pitches for motivating action Today s Webinar: To MIPS or not to MIPS Risk-bearing Medicare ACOs exempt from MIPS & 5% APM bonus Comparing MIPS vs Medicare ACO programs Medicare ACO letters-of-intent-to-apply due in May 2016 Videos and PDFs of our MIPS webinars at WEBINAR SERIES BROUGHT TO YOU BY: HITECHANSWERS.NET AND SAIGNITE.COM 3

4 Tale of the Tape: MIPS vs Medicare ACO Today s Agenda MIPS Recap Medicare ACO Primer MIPS vs Medicare ACO: Comparison Factors Comparison Example: Financial Impacts vs Quality/Cost Debut of our MIPS Financial Calculator v5 Open Q&A WEBINAR SERIES BROUGHT TO YOU BY: HITECHANSWERS.NET AND SAIGNITE.COM 4

5 The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Doc fix bill passed 92-8 by Senate Places each Medicare Part B provider into: a) MIPS, b) alternative payment models (APMs) such as risk-bearing Medicare ACOs, c) both MIPS and APM, or d) neither (small minority) 5

6 How Many Medicare Part B Providers Will Be Affected? MIPS ~ 1.0M out of 1.25M Part B Providers APMs < 0.05M providers in 52 risk-bearing Medicare ACOs (January 2016) Hence, MIPS is the new black for Part B. 6

7 Only Risk-Bearing Medicare ACOs Are Eligible APM Entities Exempt From MIPS MACRA legislation: ~ 90% of current Medicare ACOs are not risk-bearing, so may also be subject to MIPS! 7

8 MIPS Recap: Starts January 2017 Leverages PQRS, Value-Based Modifier (VBM) and Meaningful Use rules Increases and consolidates financial impacts Ranks peers nationally & reports scores publicly MIPS is budget neutral: Incentives to winners funded by penalties applied to losers Every MIPS point counts. 8

9 MIPS Recap: Components of the CY2017 MIPS Score 75% = MU + PQRS/VBM 9

10 MIPS Recap: Possible 27% in Incentives and 9% in Penalties Separate MIPS Winners & Losers CMS budget-neutral program: incentives offset by penalties 2020 Performance Year Max Base Incentive: 9%*3.0 = 27% 10

11 Medicare ACO Primer: Medicare Shared Savings Program (MSSP) ACO composed of Participant TINs CMS sets cost benchmark and shares savings and/or losses with ACO to extent determined by quality score Track 1 (one-sided), Tracks 2 & 3 (two-sided, risk-bearing) Deadline for CY2017: LOI-to-apply due May 31,

12 Medicare ACO Primer: Medicare Shared Savings Program (MSSP) (continued) Each patient attributed to at most 1 ACO based on the ACO delivering the greatest amount of primary care services to the patient All Part A & B (inpatient and ambulatory) costs for each attributed patient is included in the ACO s cost benchmark, including costs incurred by non-aco providers for each patient Realistic Example: An ACO receiving $10M/yr in Part B payments has attributed to it $200M/yr in total Part A & B costs for patients attributed to the ACO (20x difference) 12

13 Medicare ACO Primer: Next Generation ACO Program Two-sided, higher risk-bearing tracks New cost benchmarking approach prospective, regionalized Patients can choose which ACO to be attributed to Deadline for CY2017: LOI-to-apply due May 2,

14 Medicare ACO Primer: ACO Quality Measurement Measured using PQRS GPRO Web Interface method no ability to select measures Quality measure benchmarks likely different from those for MIPS (inherits Value-Based Modifier) and updated less frequently If ACO also subject to MIPS, then the same PQRS measures will also be rated for quality under MIPS May be possible to win under ACO program but lose under MIPS for the same performance year! 14

15 MIPS vs Medicare ACO: Comparison Factors Quality measurement and benchmarking Cost attribution and benchmarking Specialty vs primary care emphasis Resource requirements & coordination costs Granularity and nature of public reporting Financial impacts (next section) Compare (MIPS % adjustment of $10M Part B) versus (ACO shared savings/losses for $200M of attributed costs + 5% APM Part B bonus) 15

16 Comparison Example: Financial Impacts vs Cost/Quality SA Ignite s Free MIPS Financial Calculator v5: Assume ACO with only 1 participant TIN ASSUMPTIONS: Versus: MSR = 2.0% 16

17 Comparison Example: Financial Impacts vs Cost/Quality (cont.) ACO with 1 participant TIN: MIPS versus MSSP ACO (Track 2) versus Next Generation ACO (Risk Arrangement 2) MIPS MSSP ACO Next Generation ACO 17

18 Comparison Example: Financial Impacts vs Cost/Quality (cont.) Key Takeaways for ACO with only 1 participant TIN: Risk: MIPS < MSSP ACO < Next Generation ACO $ Impact: MIPS < MSSP ACO < Next Generation ACO Note: May change with different ACO options and input values Can set within MIPS calculator v5 If multiple participant TINs, such that any 1 TIN shares less than 100% of ACO s shared savings/losses, then ACO $ impacts reduce proportionally (except for 5% APM Part B bonus) 18

19 Free Resources New! MIPS Financial Calculator v5 (MIPS, MSSP ACO & Next Generation ACO) 10 FAQs About MIPS: or Google merit-based incentive Sign up at saignite.com for s about MIPS/MACRA tools ABC s of MIPS monthly webinar videos and PDF presentations: LinkedIn Group Merit-Based Incentive Payment System (no ads) WEBINAR SERIES BROUGHT TO YOU BY: HITECHANSWERS.NET AND SAIGNITE.COM 19

20 Open Q & A Tom S. Lee, Ph.D. CEO & Founder, SA Ignite tom@saignite.com WEBINAR SERIES BROUGHT TO YOU BY: HITECHANSWERS.NET AND SAIGNITE.COM 20