Physician practices that participate in the Centers for Medicare & Medicaid Services'
Chronic Care Management Services (CCM) program now will be better prepared later to participate in the
Merit-based Incentive Payment System (MIPS).
That's one of the key takeaways from a recent McKesson Business Performance Services' webinar on strategies and tactics to prepare physician practices for new Medicare value-based reimbursement models in the year ahead.
Jeb Dunkelberger, vice president of accountable care services at McKesson Business Performance Services, and Bill Sillar, director of strategic services at McKesson Business Performance Services, hosted the hour-long webinar, “
Outlook for Chronic Care Management and Physician Payments in 2017.”
Medicare created MIPS, which is a new value-based reimbursement model, as part of the Medicare Access and CHIP Reauthorization Act of 2015, better known as MACRA. MACRA offers the opportunity to advance the goals of delivering high-quality patient care to help put Medicare on solid footing. In 2015, Medicare also launched its CCM program to help further support the advancement of high-quality care, specifically focusing on the chronically ill patient population. The CCM program reimburses physician practices separately for coordinating non-face-to-face care to Medicare patients with multiple chronic medical conditions.
CCM and MIPS Share Common Overarching Program Goals
During the webinar, both Dunkelberger and Sillar said physician practices that participate in Medicare's
CCM program today will be better prepared in the future to participate in MIPS, which Medicare starts phasing in next year.
“CCM really offers a stepping stone into MIPS,” Dunkelberger said. “It allows medical practices to learn and understand the competencies needed to survive and profit in an arena that few practices have actually been in and one that is really pushing practices down that risk path.”
The connection between CCM and MIPS starts with the fact that the programs share Medicare's goals for physician payment reform and value-based reimbursement models. Among those goals, as outlined during the webinar, are:
- Extending care between physician office visits
- Striking the right balance between infrequent expensive provider encounters and frequent inexpensive provider encounters
- Providing opportunities to do the right thing for patients in the right setting
- Increasing care coordination across settings
- Enhancing the patient and caregiver experience
- Improving patient outcomes
CCM and MIPS Share Many Programmatic Features
In addition to sharing many of Medicare's overarching payment reform and value-based care goals, CCM and MIPS share many programmatic features, according to Dunkelberger and Sillar.
For example, practices that participate in Medicare's
CCM program must have the staff, service and technical abilities to perform five functions during the required 20 minutes of non-face-to-face time with each patient each month. As outlined in the webinar, they must be able to:
- Develop and follow a comprehensive care plan
- Perform medication reconciliation
- Manage all transitions of care
- Coordinate care among all providers
- Provide 24/7 access to urgent care services
Participating practices also must have the staff and technical expertise to collect and report data on how well they're performing on all five functions as well as the resulting impact on patient outcomes.
MIPS, meanwhile, has three weighted performance categories whose individual scores will add up to a maximum of a 100 final score. CMS will use the final score to determine whether it will increase or decrease payments to a participating physician practice. The three performance categories are:
- Quality (worth up to 60 percent of the final score)
- Advancing care information (worth up to 25 percent of the final score)
- Improvement activities (worth up to 15 percent of the final score)
In the final rule CMS postponed the implementation of the cost category until 2018 which resulted in the quality category being worth 60 percent vs 50 percent. CMS will still provide feedback on how a MIPS eligible clinician performed in 2017 under this performance category by evaluating adjudicated claims, but it will not affect payment in 2019.
Four Ways CCM Participation Prepares Doctors for MIPS
According to Dunkelberger and Sillar, the competencies required to succeed in both programs overlap in four ways, making it easier for physician practices to participate in MIPS if they're already participating in the CCM program.
1. Quality measures: In the government's over 2,000-page set of regulations implementing MIPS,
CMS published a roster of 271 quality measures from which doctors would choose, collect and report. Of those, CMS tagged 168 as “high priority” measures. Dunkelberger and Sillar said 33 measures, including 22 high priority items, are common to the CCM program. Among the common metrics are performing medication reconciliation and following a comprehensive care plan.
2. Clinical practice improvement activities: MIPS regulations listed 93 improvement activities that participating practices could engage in as part of the program. Practices in CCM already would be doing many of those MIPS-sanctioned activities such as providing 24/7 access to clinicians and coordinating care across provider settings.
3. Advancing Care Information: Promotes patient engagement and the electronic exchange of information using certified EHR technology. Practices must optimize and upgrade their EHR systems and IT expertise to capture, aggregate and report the quality measures and other performance metrics required by MIPS. Practices in the CCM program would be doing that as they demonstrate their compliance with that program's requirements in order to get paid.
4. Resource use: Although this segment has been postponed, reducing utilization and costs will count for as much as 10 percent of a practice's final score in 2018. One of the goals of the CCM program is preventing avoidable hospital admissions and readmissions. CCM practices do that by providing patient care services that target several leading causes of preventable hospitalizations like poor care transitions and medication adherence.
The Medicare population is projected to grow to nearly 80 million by 2030 from about 55 million today with two out of every three Medicare patients having two or more chronic medical illnesses, according to government figures cited by Sillar during the webinar.1 Those trends coupled with Medicare's move to value-based reimbursement models will make effectively managing the health of seniors a clinical and financial necessity for virtually all physician practices.
“Participation in the CCM program gets a medical practice on to that boat, heading in the right direction toward MIPS,” Sillar said.
Related: Learn about McKesson's Chronic Care Management Services for physician practices.