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	James L. Holly, M.D.

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Letters - SETMA: MACRA and MIPS - October 3, 2016

SETMA has prepared twelve documents on MACRA and MIPS. The following link is an attempt to integrate these documents into:

An explanation of MACRA and MIPS.
An evaluation of SETMA'S performance on the four components of MIPS for 2014 and 2015.
A plan for improving SETMA's 2017 MIPS performance in preparation for CMS’ calculation of SETMA's payment modifier for 2019 based on 2017 data which will be aggregated by CMS in 2018.

The Requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

Tools for improvement:

Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds -- tool for decreasing rates of admissions and cost of care in 2017.

SETMA’s Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial -- EMR took for increasing quality performance on MIPS quality measures in 2017 and in each year thereafter. These quality measures will change from year to year which will require the updating of this took each year.

The new payment model will be based on a healthcare provider’s or a practice’s “composite performance score” (CPS). This score will be made up of the following percentages in the first year:

Quality (50%) – An extension of PQRI, then PQRS and ultimately MIPS Quality Metrics, coupled with rates of admissions for certain conditions.
Resource Use (10%) – The total beneficiary cost of care benchmarked against similar practices
Advanced care information (25%) – Meaningful Use of a certified EMR
Clinical Practice Improvement Activity (15%) – Patient-Centered Medical Home recognition at the highest level, i.e. NCQA TIER III PC-MH fulfills this category 100%

Ultimately, at some point in time, it is expected that each of these four categories will have equal weight in the calculation of the “composite performance score.”

James (Larry) Holly, M.D.
C.E.O. SETMA
www.jameslhollymd.com

Adjunct Professor
Family & Community Medicine
University of Texas Health Science Center
San Antonio School of Medicine

Clinical Associate Professor
Department of Internal Medicine
School of Medicine
Texas A&M Health Science Center

Related Articles

	Clinical Quality Measures (CQM) - Part of the Future of Healthcare PQRI and PQRS - Part of the Past which Created the Future Part I Four categories defined by MIPS Correlate with Four Strategies SETMA Defined in 2000-2005 Part II Four categories defined by MIPS Correlate with Four Strategies SETMA Defined in 2000-2005 Part III Four categories defined by MIPS Correlate with Four Strategies SETMA Defined in 2000-2005 SETMA’s Innovations Over the Past Twenty Years Have Prepared Us for MACRA & MIPS What are MACRA and MIPS? Why Should I care?
Related Tutorials

	SETMA’s Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial
Related Letters

	CMS Quality Resource and Utilization Report (QRUR) data for 2015 for SETMA CMS Quality Resource and Utilization Report (QRUR) data for 2015 for SETMA - Final Four Categories Defined by MIPS Correlate with SETMA’s Four Strategies for Transforming SETMA and Healthcare In 2000 SETMA Anticipated Four MIPS Categories MACRA and MIPS: An Analysis of the Final QRUR for the Full Year 2015 MACRA MIPS Where Does SETMA Stand MIPS Payment Adjustment in 2019 MIPS September 2016 Advanced Care Information (MU) & Clinical Practice Improvement (PC-MH) MIPS September, 2016 Nursing Home Population – Pneumonia, Urinary Tract Infection, Dehydration SETMA's Prescient Preparation for MACRA and MIPS September 2016 The Requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) What is Post Acute Care?

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