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

"Infinitum" Practice Transformation

At VPQHC we cover the whole spectrum of healthcare in Vermont, and increasingly the whole care continuum as the United States begins to change thinking in this area to embracing the social and behavioral determinants of health. As the only neutral healthcare quality organization mandated by statute in the state of Vermont, we take our role in guiding the development of the statewide healthcare quality system very seriously. 

Primary Care and Specialty Practices have been historically under served with high quality, independent assistance in their operations, strategy and growth pathways as they struggle to adapt to the rapidly changing world of value based compensation from the traditional fee for service world. Recognizing this, we took a long hard look at the needs of this sector, matched it with our broad and deep experience and expertise bases and developed a practice transformation center of excellence. 

"What's a practice transformation center of excellence?" Well, we have been the Vermont partner in the Northern New England Practice Transformation Network for over a year now, assisting practices across the state (and in NH) with their efforts to transform their structures and operations to better live in the changing reimbursement environment of MACRA and MIPS. We have been instrumental in refining and extending the Transforming Clinical Practices Initiative (TCPI) methodology into a system that truly guides the practice to a higher performing state. In addition to this, we have taken our own experience bases and extended our practice transformation system far beyond that in TCPI to a truly holistic system capable of taking any practice from struggle to supreme performance. We call it the Infinitum Method because the scope of improvement is limitless with the right guidance and coaching. 

Over the coming months, you'll begin to see more about this in our materials, communications and events. As we launch educational and service offerings, we will be in touch to get your feedback and discuss opportunities for us to work together to truly transform your practice. If this is something you would like to find out more about, please call us on (802) 229 2152 or email me at