Medicare Part B Clinicians billing > $30k/year, care to > 100 Medicare patients/year

The path to value-based care.

QPP reality check.Real-world impact to your clinicians, patients and bottom line.

For both clinicians... ...and care settings.

Our survey of healthcare finance executives reveals that there is a significant lack of knowledge around the implications of CMS’ Quality Payment System (QPP).

of the respondents are confident they understand all the requirements associated with QPP.

61% 56% of respondents said they were ready to meet QPP reporting requirements.

2017 20192018

50%30%

60%

CostClinical ImprovementAdvancing Care InformationQuality

And the impact?Far reaching.

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Ease your transition to MACRA.

ACOs or Medicare Advantage plan participants

of participants

Higherrisk

30%

CMS will publish MIPS performance scores for more than 400,000 Medicare clinicians (2017)

70%of participants

(APM)

Advanced AlternativePayment Models

But consumers probably won’t think that’s a winning score.Get >3 points (out of 100) to avoid penalties.

★★★★★ ★★ ★

Physicians Hospitals

Clinical DocumentationImprovement Teams

Coding Teams

There are five clinical roles in scope for 2017 and 2018, and CMS has discretion to add up to 8 more clinical roles in year 3 (2019).

Hospital reputations are on the line.

CDI teams are going to be the linchpin in identifying not only documentation issues, but oppor-tunities for improved data map-ping with your EHR vendors.

Physician documentation will have to take a deeper dive under QPP and there will be a significant focus on ICD-10 specificity and clarity, as well as HCCs, especially if you are considering participating in an APMs.

Ambulatory Careand ClinicsCMS is offering an option for small practices and solo physicians to join in virtual groups and submit com-bined MIPS data.

Main HospitalPatients/Visitors

Ambulatory CareCenter

Medical Offices

EMERGENCY

(MIPS)

Merit-based Incentive Payment System

of those who stated their confidence inunderstanding program requirements,under-estimated or did not know, the financial impact.

Scoring

Bottom line

Medicare reimbursement for all clinicians paid under the Medicare Physician Fee Schedule will be affected.

Performance scores potentially will amount to millions of dollars per organization and will increase significantly. Penaltiesassessed for poor performance or noncompliance will be used to fund incentive payments for high performers. Every MIPS point will have an impact financially.

PatientsProviders will need to form better relationships with their patients and proactively manage their health. This is the result of greater care coordination and two-sided risk.

25%25%25%

15%15%15%

10%

30%

You may think you’re ready. But are you really ready?

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