Advis’ Propriety Strategic Readiness Assessment Can Help

To ensure readiness for 2017 reporting and beyond, Advis is helping medical groups and health systems develop strategic plans that will maximize bonuses and minimize penalties under MACRA, the Quality Payment Program (QPP), Merit-based Incentive Payment System (MIPS), and Alternative Payment Models (APM).

Strategic planning beginning in 2017 is essential to minimize current and fare future reimbursement penalties (up to 4% of Medicare Part B payments) and maximize bonus payments (up to an additional 4% of bonus reimbursement for MIPS participants and up to 5% for advanced APM participants). Selecting the appropriate participation method and quality measures for tracking/reporting in 2017 is the first step to doing so.

To achieve bonus reimbursements and/or avoid any negative payment adjustments in 2019, providers are required to report based on 2017 performance. Providers must either (1) adequately participate in Advanced APMs or (2) successfully report through MIPS. Advanced APM Qualifying Participants must have a certain threshold of patients or payments through their APM. For MIPS providers, their performance will be measured across the four MACRA/MIPS domains (quality, technology, improvement activities, and cost). Above-average performance in one or both of these areas will likely lead to significant bonus payments in future years.

In addition, 2017 performance will impact providers’ 2018 performance and, thus, future penalties and bonuses. Specifically, the proposed rule released last month confirmed that providers’ 2017 quality metric performance will likely establish 2018 scores for cost and improvement activities. Therefore, strategic selection of such metrics will be essential for success in future years.

The Advis Group’s proprietary strategic readiness assessment robustly models future state through a rigorous nine-step process:

  1. Determine which, if any, providers participate in an APM and what level of participation is currently reported.
  2. Review and assess performance for 2017 to date (APM and MIPS).
  3. Review past and expected trends in quality metrics for past and future years.
  4. Assess how long-term strategic plans and subsequent changes to provider mixes may impact the overall adjustment score.
  5. Understand how the reporting mechanism will affect the measures selected and what the best reporting mechanism is for the group.
  6. Prepare a 2019-2020 financial projection based on expected performance in 2017 and 2018.
  7. Assess how those measures will impact future years’ payment adjustments based on the Improvement Scoring bonuses.
  8. Determine if the patient population is likely to receive a Complex Patient Bonus.
  9. Analyze whether participation in a “virtual group” may be beneficial in future years, pending CMS proposals.

The result is a multi-year approach which ensures providers avoid a negative payment adjustment and establish a strong position to receive future bonuses.

Advis is available to perform a strategic readiness assessment and prepare multi-year strategic plans to help providers avoid a negative payment adjustment and establish a strong position to receive future bonuses.

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