1. MACRA and Primary Care Informatics
Mark A. Parkulo, MD, CPHIMS
Diplomate, Clinical Informatics
Chair, Meaningful Use Oversight Group
Mayo Clinic
Mayo Clinic Office of Information and Knowledge Management
AMIA 2017
November 2017

2. Disclaimer
I have no financial disclosures or conflicts of interest concerning this lecture.

3. Medicare Access and CHIP Reauthorization Act vs. Affordable Care Act
MACRA
ACA (Obamacare)
Medicare payment reform
Bi-partisan support
Replaced SGR Formula
Access
Supported by HHS Sec. Tom Price
Insurance reform
No Bi-partisan support
Expanded Medicaid
Access
Not supported by HHS Sec. Tom Price

4. MACRA Replaced Sustained Growth Rate Formula Medicare payment model
Yearly “Doc-fix”
Designed to pay for value
Two payment models
Advanced Alternative Payment Models
MIPS

5. Advanced Alternative Payment Models
Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes.
You may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

6. Advanced Alternative Payment Models 2017
Comprehensive ESRD Care (CEC) - Two-Sided Risk
Comprehensive Primary Care Plus (CPC+)
Next Generation ACO Model
Shared Savings Program - Track 2
Shared Savings Program - Track 3
Oncology Care Model (OCM) - Two-Sided Risk
Comprehensive Care for Joint Replacement (CJR) Payment Model (Track 1- CEHRT)

7. Merit-based Incentive Payment System
Combines several payment incentive programs
PQRS, Meaningful Use, Value Based Modifier, and Improvement Activities (New)
Zero Sum Game
High performing providers will see increases in payments which will be offset by decreases in payments to low performing providers
Cost will be factored into equation in 2018

9. Cost/Resource Use

10. Quality Payment Program

11. MIPS Timeline

12. MACRA and the Trump Administration
Unlikely to make substantive changes to law due to broad bi-partisan support
Will likely alter regulatory requirements presumably to reduce regulatory burden on providers
Pay for Value will replace Pay for Volume
Advanced Alternative Payment Models will become more commonplace

13. MACRA and Primary Care Informatics
Cost-effective models
Population Health
Efficient EHRs to support Primary Care
Learning Health System

14. The age of Fee for Service is over, the time to Pay for Value has come.
… if you’re not ready, it could get ugly.