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November 2016

LHP's Key takeaways from MACRA final rule

The Centers for Medicare and Medicaid Services (CMS) recently issued the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). At this week’s LHP Board meeting, staff presented its analysis of the final rule, specifically related to payments and eligibility, quality, and other performance categories.

Payments and eligibility

* Practices are incentivized to perform well and report for the full year due to the addition of an exceptional performance adjustment
* CMS relaxed the nominal risk requirements – MSSP Track 1 does not qualify; but CMS plans to offer new APMs in the future, including a MSSP Track 1+ option
* CMS changed the low-volume threshold exemption to clinicians with fewer than $30,000 in annual charges, up from $10,000


* Quality accounts for 60% of an Eligible Clinician’s (EC) composite performance score in 2017; providers are evaluated on:
    - Submission of up to six measures, one of which must be an outcome measure
    - One population-based measures calculated from claims data (All-Cause Readmission)
* Full-year reporting will be required in 2018 and providers will be scored based on how they compare to competitors

Other performance categories

* Cost is weighted to zero, yet it will quickly increase to 30% of the composite performance score
* CMS reduced the points needed to achieve the highest total score in the Improvement Activities category; ECs now must only earn 40 points
    - Medical Homes earn the full 40 points outright
* There is added flexibility in Advancing Care Information; ECs only need to report on 4 measures for modified stage 2 and 5 measures from stage 3, down from 11
    - To maximize score, ECs need to earn just 50 of the additional 90 points available in the performance section of the score

Advisory Board takeaways on MACRA final rule

The Advisory Board recently published an article about the 2,298-page MACRA final rule. Advisory Board Senior Director for Health Policy Eric Cragun called out these key takeaways:
1. Clinicians will find it far easier to comply with MIPs (Medicare’s Merit-Based Incentive Payment System) in 2017.
2. More providers will qualify for the APMs (Advanced Payment Models) track.
3. CMS is showing a big commitment to reducing administrative burden.

Read the Advisory Board article here.

LHP and Legacy advocate on providers’ behalf

In response to the MACRA final rule, this week Legacy Health and Legacy Health Partners sent a letter to CMS expressing support for some of the flexible guidelines CMS is proposing to provide under both the MIPS and APMs programs. The letter also clearly stated both organizations’ broad concerns about what it means to participate in the Medicare Shared Savings Program (MSSP) as both a network and as an independent practice.

A letter signed by Legacy Health President and CEO George Brown, M.D., FACP, and Rob Bentley, M.D., LHP Board chair, provided comment specific to the MACRA final rule and reiterated LHP's reasons for withdrawing its application for MSSP Track 1: 
  • Unclear understanding about how a provider’s performance scores would be shared publicly
  • The support and time needed to help practices with EMR technology and reporting 
  • Unaligned cost and expense targets with other Medicare shared savings programs, e.g., Comprehensive Primary Care Plus (CPC+).

Drs. Brown and Bentley asked that as CMS continues to roll out new value-based programs, there be clear guidance on how each program might impact patients and practices.

MACRA info sessions for practice administrators – Skype details

LHP is offering three information sessions to help practice administrators learn about MACRA and implications for their practices. Attend in person or by SKYPE:
Nov. 22, noon-1 p.m. – Legacy Meridian Park Medical Center
Nov. 29, 7-8 a.m. – Legacy Good Samaritan Medical Center
Dec. 8, noon-1 p.m. – Legacy Salmon Creek Medical Center

Skype details for all sessions:
Call to join the conversations: 503-415-5222
Log in to Skype meeting here.

3 things to focus on in Nov. and Dec.

  1. Increase the LHP Network’s breast, cervical or colorectal cancer screening reported performance: In September we sent providers and practice administrators a spreadsheet and instructions for submitting data for any Legacy Employee Health Plan patients who had a relevant cancer screening, but that screening has not yet shown up in claims data. If you complete your spreadsheet, LHP staff can manually input this information into our records to more accurately capture the network’s performance for cancer screening. If you need help, reach out to your Field Operations Adviser or call LHP at 503-415-5109.
  2. Complete one of the five learning modules. Read the descriptions here. Learn about tobacco cessation, opiate prescribing, performance excellence and more. Complete one learning module to earn a point on your 2016 clinical integration score. 
  3. Remember to attest for the provider and practice measures that you complete or satisfy. Go to the Legacy Health Partners Resource section on your LHP Dashboard and attest to each measure there. The data on your dashboard updates every Sunday evening.

What we learned: Provider Forum on cervical cancer screening

Riyad Fares, M.D., LHP Medical Director

About two weeks ago, the LHP team went to Mt. Hood Women’s Health in Gresham to hold our second Advisory Forum on the topic of cervical cancer screening. Cervical cancer is the fourth most common cancer after breast, lung, and colon cancer, and pap smear testing is a foundational component of preventive health care. In our 2015 LHP pilot, we were surprised that our performance for cervical cancer screening was 69.4%, about 6% below the national benchmark of 75% that our network set out to achieve. Read the rest of the story.

Legacy Health Partners Mission: Delivering value and improving health

Learn more at www.LegacyHealthPartners.org

Questions? Call 503-415-5109.