MACRA and MIPS and APM's - oh my!

Part of our work at VPQHC is with the Northern New England Practice Transformation Network (NNE-PTN) working with practices to help them transition their operations to be more successful in the upcoming value based payment systems such as Advanced Alternative Payment Models (AAPM's) and the new Merit Based Incentive Payment system (MIPS). We use a transformation methodology from CMS called the Transforming Clinical Practices Initiative (TCPI) which examines a practice within 27 distinct domains, evaluating the maturity level of each domain and producing a structured action plan to take those domains to their next stages of maturity. It's a complex process, and takes significant time, which is why the typical TCPI engagement lasts four years. 

The Medicare Access and CHIP Re authorization Act of 2015 (MACRA) mandated CMS with producing the MIPS system to replace the PQRS, Value Based Modifier, Meaningful Use and Resource Utilization Index measures, and produce one integrated system to be a "catch all" for practices that are not joining an advanced alternative payment model such as an Accountable Care Organization (ACO). (Practices joining ACO's have their own criteria and system to ensure they move to value based payments.)

The time line for these changes has caught a lot of practices by surprise. The first reporting year starts Jan 1 2017 (in about 6 weeks) and many practices either do not know of these changes, or are doing very little to change their operations to work within the new system.  MIPS has provisions to impose positive and negative modifiers on medicare payments, beginning with +/- 4% in 2019 (based on 2017 results) and up to +/- 9% in 2022 (based on 2020 results). If your practice has significant medicare billings, these figures will start to impact your financial performance starting 2019. 

TCPI is designed to help you navigate MIPS, submit data to CMS appropriately and design your operations to more effectively produce value, which is reflected in the MIPS scores. For any practices that are not currently in an advanced alternative payment model, a CMMI demonstration project (such as the Blueprint for Health in VT) or other CMS funded program, TCPI offers 3 years of free technical assistance to help you configure your practice to succeed in this new environment. In VT we currently have 22 practice slots available for the TCPI program. If you would like to discuss options, please don't hesitate to contact me at