1. Optimizing the Value-Based Revenue Cycle: The Merit-Based Incentive Payment System (MIPS) WI-HFMA, May 27, 2016 Tom S. Lee, Ph.D. CEO & Founder SA Ignite

2. Learning Objectives 1.Understand the back-office mechanics of the forthcoming Merit-Based Incentive Payment System (MIPS) value-based Medicare Part B program and its components, including PQRS, Meaningful Use, and Value-Based Modifier. 2.Learn and apply best practices to identifying revenue leakage and audit risks associated with the back-office management of value-based payment programs. 3.Apply shared field experiences and specific examples of optimizing the value-based revenue cycle to improving your back-office processes and systems. 2

3. Agenda Our Background in MIPS MIPS 101 Value-Based Revenue Cycle Optimization in Action: MIPS Quality Reporting Method & Measure Selection Q & A 3

4. Our Background in MIPS 4

5. We Optimize the Value-Based Revenue Cycle for 13,000+ providers 5

6. MIPS/MACRA Thought Leadership 6 http://www.modernhealthcare.com/article/20160430/MAGAZINE/304309988/docs-face-stark-choices-under-new-medicare-pay-proposal Published April 30, 2016, 3 days after release of the MACRA proposed rule

7. Google Rankings for MIPS 7

8. MIPS 101 8

9. MACRA Passed April 2015 (Medicare Access & CHIP Reauthorization Act of 2015) 9 “Doc fix” bill approved 92-8 by Senate The Quality Payment Program (QPP) places each Medicare Part B provider into: a)Merit-Based Incentive Payment System (MIPS), b)Advanced Alternative Payment Models (Advanced APMs) such as Track 2/3 MSSP ACOs, c)both MIPS and Advanced APM, or d)neither

10. MACRA Rulemaking Timeline 10 April 27, 2016: MACRA draft rule released By November 1, 2016: Release of final rule January 1, 2017: First performance year begins

11. How Many Medicare Part B Clinicians Will Be Affected? 11 MIPS ~ 800,000 out of 1.25M providers* Advanced APM < 20,000 providers (mostly in Medicare ACOs) Hence, MIPS is the “new default” for Medicare Part B clinicians. *CMS estimate in MACRA Proposed Rule

12. MIPS Eligible Clinicians 12

13. MIPS Starts January 2017 13 Leverages and augments PQRS, Value-Based Modifier (VBM) and Meaningful Use rules Increases and consolidates financial impacts Ranks peers nationally & reports scores publicly MIPS is budget neutral: Incentives to winners funded by penalties applied to losers

14. Components of the CY2017 MIPS Score 14

15. Unlike Historical MU, ACI Scoring is a Continuous Scale, Not All-or-Nothing* 15 *MACRA Proposed Rule – May change in Final Rule From CMS NPRM Fact Sheet Performance Score: Each measure scored on a decile scale to earn up to 10 points Key Takeaway: High, historical MU compliance does not guarantee a high ACI score. Similarly, historically avoiding PQRS/VBM penalties does not mean the MIPS quality score will be high enough to avoid MIPS penalties without additional effort.

16. Financial Impacts of MIPS are Significant 16

17. 4-Year Average Annual Payment Adjustment Versus MIPS Performance Score 17

18. 5 Things to Do Now to Prepare for MIPS 18 1.Educate your organization, particularly the C-suite, as soon as possible, e.g. leverage MIPS Financial Calculator 2.Estimate your MIPS score (stay tuned for our forthcoming tools) 3.Optimize MU (ACI) & PQRS/VBM Quality to maximize MIPS score –Comprise 75% of the CY2017 MIPS score –See following section regarding MIPS Quality category optimization 4.Evaluate staff, resources and organizational structure –e.g. combine MU & PQRS efforts under a single leader 5.Identify CY2016 deadlines impacting CY2017 MIPS –e.g. MSSP ACO or PCMH application deadlines to gain MIPS exemptions or points

19. Educate Your Organization: Free Resources to Help 19 10 FAQs About MIPS: Google “merit-based incentive” http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips Free MIPS Financial Calculator: Google ”mips calculator” http://www.saignite.com/mips-solutions Recorded ABCs of MIPS monthly webinars: 250+ attendees/webinar http://www.saignite.com/resources/hitech-abc-of-mips-webinar LinkedIn Group “Merit-Based Incentive Payment System” (no ads)

20. Estimate Your MIPS Score: Example from a Client Engagement 20 ACI (max 25): We predicted 75% ACI performance, translates to 19 MIPS Points Quality (max 50): We predicted VBM Quality = -0.36, translates to 21 MIPS Points Resource Use (max 10): 2014 VBM Cost = 0.12 translates to 5 MIPS Points Clinical Practice Improvement Activities (max 15): Assume 2/3 achievement, or 10 MIPS Points Estimated MIPS Score: 19 + 21 + 5 + 10 = 55 (1-2% MIPS incentive)

21. Value-Based Revenue Cycle Optimization in Action: MIPS Quality Reporting Method & Measure Selection 21

22. Selection of PQRS Reporting Method or Measures Can Greatly Impact VBM & MIPS Quality Scores 22

23. Many PQRS Methods to Choose From 23

24. PQRS Measure Selection Complexity 24 SA Ignite Proprietary and Confidential To maximize VBM scores, measures must be selected from among… …across Individual-Provider and GPRO PQRS reporting methods. Measure values subject to audit up to 7 years after submission. Also, for GPRO, should you opt-in to include the CAHPS patient experience survey measures in the VBM Quality Score or not? PQRS measures ~298 total PQRS measures ~298 total EHR Direct: 64 CQMs GPRO web interface: 17 measures Registry: ~280 measures Individual measures Measures groups

25. PQRS Method Selection Fraught With Interrelated Decision Factors 25

26. Develop a PQRS Method Selection Decision Tree and Estimate Decision Impact on MIPS Score 26

27. Summary 27 The financial stakes of MIPS are very high Penalties fund the incentives for the winners Every MIPS point counts Past success in MU or PQRS/VBM does not guarantee a high MIPS score nor avoiding MIPS penalties There are things you can do now to prepare for MIPS

28. Q & A Tom Lee tom@saignite.com tom@saignite.com 28