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Advancing Care Information (ACI) Category – MACRA Monday

Posted on February 6, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

Time to continue our journey through the MIPS performance categories. For today’s MACRA Monday we’re going to start talking about the Advancing Care Information (ACI) category. Most of you will know this category better as meaningful use. However, it does have some significant changes to what existed in meaningful use.

Some of the major changes include a shift from the “All or Nothing” approach to the EHR meaningful use program. CPOE and CDS objectives were also eliminated along with some redundant measures. ACI also reduces the number of required public health registries.

As we mentioned previously, ACI makes up 25% of your MIPS Composite Scoring. There is a significant hardship exemption available that will change the ACI weighting to zero and apply the 25% weight to other categories. Here’s a look at how the ACI score will be calculated:

The biggest piece of ACI scoring is the 5 required measures that make up the base score as follows:

Much like meaningful use, in advancing care information (ACI) clinicians are required to use a certified EHR. Which EHR certification you use will determine which ACI objectives and measures you will need to use as follows:

That’s the quick overview of the Advancing Care Information (ACI) category. Next week we’ll take a look at the MIPS APM benefits and MACRA small practice support.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

Cost and Clinical Practice Improvement Activities (CPIA) Categories – MACRA Monday

Posted on January 30, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

We’re continuing to move through the various MIPS performance categories as we cover the details of MACRA. Today we’re going to cover the Cost and Clinical Practice Improvement Activities (CPIA) Categories.

MIPS Cost Category
We won’t cover much of the Cost (Formerly known as Resource Use) category since it has basically been relegated to future MACRA requirements. For those that missed it, the cost category has a weighting of 0% in 2017, so it basically won’t impact your MACRA payment adjustment at all. In 2017, they’re looking at feedback for this category, but it won’t affect your 2019 payments.

You’ll probably remember that the Cost category was the replacement to the value-based modifier and didn’t require any reporting on the part of the provider. Instead, the cost category is tracked using the Medicare claims data. This means that CMS will still have the data they need to evaluate this category without any additional work from providers.

MIPS Clinical Practice Improvement Activities (CPIA) Category
You’ll remember that the Clinical Practice Improvement Activities (CPIA) category is a new category that was added as part of MACRA. This category will account for 15% of your MIPS score. This category has some small practice exceptions and also special credit for those participating in a patient-centered medical home or other similar medical home model.

Under CPIA providers must choose from 90+ activities in the following 9 subcategories:

CPIA will be scored on a total of 40 points with “Medium” activities scoring 10 points and “High” activities scoring 20 points. These point totals are doubled for small, rural, and underserved practices. That means that small practices only need to do 1-2 activities to get full credit for this category. Larger practices only need to do 2-4.

The Cost and CPIA MIPS categories only make up 15% of your total MIPS score. So, they’re not going to be a significant impact on your MACRA score either way. However, if you do even just 1 improvement activity (CPIA), then you’ll avoid any negative payment adjustment thanks to MIPS pick your pace.

That’s all for this week’s MACRA Monday. Next week we’ll talk Advancing Care Information (ACI) or what most of you call meaningful use.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

MIPS Quality Performance Category – MACRA Monday

Posted on January 23, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

It’s time to start diving into more of the details of the MIPS performance categories. For reference, be sure to check out our previous post on the MIPS Performance Category Weightings to see how the Quality performance category fits in with the other MIPS performance categories. The Quality performance category makes up 60% of your MIPS composite score. So, this is a very important category. If you’re looking for a formal course that dives into the nitty gritty details of this category, check out this course taught by Wayne Singer that covers the MIPS Quality Performance Category ($150 off the course if you use this link) in detail.

The Quality performance category is a replacement of the program we now know as PQRS. The program is simplified a little and they have created specialty specific measure sets. This is a valuable resource since the number of measures available in the quality performance category is quite large.

In the Quality performance category you must select 6 measures and at least one measure must be an outcome or high-priority measure. Scoring of these measures will go as follows:

Here’s how you calculate your quality performance category score:

If you’ve been participating in PQRS, this MIPS performance category won’t be a big issue for you. You’ll likely achieve a high score and be well on the road to doing very well with MIPS. If you haven’t been doing PQRS, then you have some work to do. The nice thing is that there are a lot of organizations with experience with PQRS and you can learn from them. Plus, your EHR vendor should be very familiar with PQRS as well and should be able to help.

That’s all for this week’s MACRA Monday. Next week we’ll talk about the Cost Category and new Clinical Practice Improvement Activities (CPIA) Category.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

MIPS Performance Category Weightings – MACRA Monday

Posted on January 16, 2017 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of the MACRA Quality Payment Program.

We’re going to keep this post short and sweet since it’s a holiday. However, we wanted to keep going with our regular MACRA Monday series. As we start to talk about the details of MIPS, the key change in the MACRA final was removal of the “Cost” category from MIPS. Ok, it wasn’t really removed. It’s still apart of MIPS, but it doesn’t influence the payment adjustment that you’ll receive. For those following along at home, the cost performance category in MIPS was a replacement of the Value Based Reimbursement Modifier.

Here’s the full breakdown of the 4 MIPS Performance Categories and how much weight each category will get in determining your MIPS Composite Score:

As a reminder, the Quality category replaces the old PQRS program. The Improvement Activities category is a new category. The Advancing Care Information category is the meaningful use replacement. We already mentioned that the Cost category is a replacement of the Value Based Reimbursement program.

Looking at the weights above, if you’re participating in PQRS, then MIPS is not going to be an issue for you. If you’ve been doing PQRS and Meaningful Use, then you’re well positioned to get access to the extra incentives available under MIPS. Although, remember that the MIPS incentives are subject to budget neutrality.

That’s the basic overview of the MIPS categories. Next week we’ll start diving into more details on each category.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA Quality Payment Program.

MIPS Performance Categories and the MIPS Composite Score – MACRA Monday

Posted on August 29, 2016 I Written By

John Lynn is the Founder of the HealthcareScene.com blog network which currently consists of 10 blogs containing over 8000 articles with John having written over 4000 of the articles himself. These EMR and Healthcare IT related articles have been viewed over 16 million times. John also manages Healthcare IT Central and Healthcare IT Today, the leading career Health IT job board and blog. John is co-founder of InfluentialNetworks.com and Physia.com. John is highly involved in social media, and in addition to his blogs can also be found on Twitter: @techguy and @ehrandhit and LinkedIn.

This post is part of the MACRA Monday series of blog posts where we dive into the details of MACRA.

As mentioned, next up we’re going to cover the 4 MIPS performance categories. Each of these categories are listed in the graphic below and will contribute to what is called your MIPS Composite Score.
MIPS Performance Categories

At first, these four new category names might be confusing, but here’s the translation you need to know for each category that will illustrate how MIPS really just rolls up three existing programs and adds one new program as follows:

  • Quality Performance Category – PQRS Replacement
  • Resource Use (Cost) Category – Value Based Modifier Replacement
  • Clinical Practice Improvement Activities Category – New
  • Advancing Information Category – Meaningful Use (EHR Incentive Program) Replacement

I’m not sure why the government thought we needed new names for each program, but they decided that was the best route. Maybe they wanted to leave the past behind and move forward without the baggage that exists with the previous names. Regardless, 3 of the 4 MIPS performance categories are programs that most of you probably already know about. There are slight changes with each of the 3 programs (PQRS, Value Based Modifier, and Meaningful Use) under MIPS which we’ll cover in a future part of this series. In most cases, each of those 3 programs was simplified under MIPS.

In order to determine your MIPS Composite Score, each provider will receive a score on a 100 point scale. Each of the 4 performance categories contributes to the 100 point scale and have been weighted as follows:
MIPS Performance Categories Weighting - Year 1

Yes, that means that if you are already doing PQRS (Quality) and Meaningful Use (Advancing Care Information), then you’ll be well positioned for 75% of the points for the MIPS composite score. If you’re only doing PQRS, you’re still in a position to get 50% of the MIPS composite score without too many changes from what you’re doing today. Of course, that assumes you continue those efforts under the modified MIPS requirements in 2017. If you’re not doing PQRS, meaningful use, or value based reimbursement, then you’ll have some serious work to do in order to not be penalized under MIPS.

Once CMS calculates your MIPS composite score, they’ll compare that score against the threshold to determine the adjustment received. Speaking hypothetically, let’s say the MIPS threshold was set at 64 and your MIPS Composite Score was 64. Then, you wouldn’t receive an increase or decrease to your reimbursement. Of course, if you scored above a 64, then you’d receive a bonus payment. If you score below a 64, you’d be penalized.

CMS has said they intend to publish the benchmarks and thresholds prior to 2017. Given the short time frame, this is going to be a real challenge and is likely another reason why it’s possible that MACRA could be delayed. However, it’s good to know that they’re planning to publish the MIPS threshold in advance so practices can plan accordingly. The great part of this scoring system is that unlike meaningful use which was all or nothing, this scoring gives providers credit for partial performance.

It’s worth also noting that the MACRA program must be budget neutral. So, if more providers are getting penalized than are getting incentives, the HHS Secretary will use a scaling factor to increase the incentives paid to participating providers that qualify. HHS also has $500 million available separate from the normal incentive payments to reward exceptional performance. I have yet to see details on this, but it will be interesting to watch and see what they use as the criteria for exceptional performance. I wonder how much higher of a composite score you’ll need above the threshold to be considered an exceptional performer.

Next week we’ll start going through each of the performance categories at a high level and discuss the changes made to each program that’s been rolled into MIPS and the new Clinical Practice Improvement Activities category.

Be sure to check out all of our MACRA Monday blog posts where we dive into the details of the MACRA program.