October 26, 2016
As SETMA began thinking about and trying to understand the Medicare Access and CHIPS Reauthorization Act of 2015 (MACRA) and the Merit-Based Incentive Plan System (MIPS), we analyzed our efforts to transform SETMA since 1995 in relationship to MACRA and MIPS. We received CMS’s QRUR reports on SETMA’s performance in 2014 and 2015. We analyzed that performance and designed solutions for improvement in quality and cost. The annotated articles below are the work in that process giving details about the steps we went through.
- This August 25, 2016 article is the first step SETMA took in order to both understand and to publicize the elements of MACRA and MIPS. It describes and explains the Composite Performance Score and gives SETMA’s assessment at that point of our readiness for MIPS.
What are MACRA and MIPS? Why Should I care?
- This link looks at CMS’ Quality Review and Utilization of Resource Utilization (QRUR) and relates the four MIPS categories to SETMA’s previous work and shows the results of CMS’ review of SETMA for 2014 and 2015.
SETMA's Prescient Preparation for MACRA and MIPS September 2016
- This describes SETMA’s September 24, 2016 analysis of MIPS’ Four Categories and SETMA’s assessment that we fulfill each of the categories’ requirements.
MIPS Payment Adjustment in 2019
- This is SETMA’s October 8, 2016 comparison of SETMA Four Standards of Care and the Four Categories of MACRA and MIPS. This analysis goes into detail of SETMA’s concerns about MIPS and relates MACRA and MIPS to SETMA’s Model of Care and Analytics Program. It also describes how MIPS could be improved. SETMA finds it remarkable that standards we describe 15 years ago are now the categories of MIPS.
Four Categories Defined by MIPS Correlate with SETMA's Four Strategies for Transforming SETMA and Healthcare
- This describes how SETMA’s innovations and progress over the past twenty years have prepared us for MACRA and MIPS
SETMA's Innovations Over the Past Twenty Years Have Prepared Us for MACRA & MIPS
- This is an explanation of MIPS’ Advancing Care Information category which is an extension of Meaning Use and our assessment of where SETMA stands.
MACRA MIPS Where Does SETMA Stand
- MIPS, SETMA and Clinical Practice Improvement which is one of the categories of MIPS, which is fulfilled by NCQA PC-MH recognition at the Tier 3 level. SETMA has been a Tier 3 PC-MH by NCQA since 2010 and our current recognition expires in 2019. We simultaneously hold accreditation from AAAHC, URAC and Joint Commission for PC-MH and Ambulatory Care.
MIPS September 2016 Advanced Care Information (MU) & Clinical Practice Improvement (PC-MH)
- The quality reporting element of MIPS is an extension of the 2006 PQRI voluntary quality reporting initiative and the 2011 PQRS which was a required reporting initiative. The following describes both programs and SETMA’s participation in each.
Clinical Quality Measures (CQM) - Part of the Future of Healthcare PQRI and PQRS - Part of the Past which Created the Future
- This link is SETMA’s QRUR through the end of June 2015: SETMA’s Results on All Four MIPS’ Categories.
MID-YEAR QUALITY AND RESOURCE USE REPORT
- This link shows SETMA’s QRUR for the full year ending December 2015
2015 ANNUAL QUALITY AND RESOURCE USE REPORT AND THE 2017 VALUE-BASED PAYMENT MODIFIER
- This is SETMA’s analysis of CMS’s QRUR for SETMA for 2014 and 2015 with our identification of opportunities for improvement in our performance both as to quality and as to cost.
MACRA and MIPS: An Analysis of the Final QRUR for the Full Year 2015
- This is another review of SETMA’s 2014 and 2015 performance on the issues raised by MACRA and MIPS. It gives the scatter graph for quality and cost which shows where SETMA is on both. Our goal is to move further into the right upper quadrant for high quality and low cost.
The Requirements of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
- This is an updated summary as of October 3, 2016 of SETMA’s analysis of our preparation for MACRA and MIPS. It gives an explanation, evaluation and plan for improvement.
SETMA: MACRA and MIPS - October 3, 2016
- This is another brief review of SETMA’s work from 1998-3016 which prepared us to fulfill the four categories of MIPS
In 2000 SETMA Anticipated Four MIPS Categories
- This is a tutorial for of SETMA’s quality improvement initiative for MIPS. All SETMA providers are using this tool and we are doing daily audits on our performance.
SETMA's Merit-Based Incentive Payment System (MIPS) Quality Metric Tool Tutorial
- This is an analysis of areas where SETMA’s cost is above the mean. While we are still well below one standard deviation, we think there are explanations for our increased cost in these areas furthermore we think we can do something about this cost, while maintaining the quality of our care. SETMA treats over 1,500 patients in long-term residential care settings where pneumonia, UTI and dehydration are major problems. We have already discussed and designed ways to decrease the hospitalization of these patients. The following is one tool we created to help solve this problem: Outpatient Infusion Center for Intravenous Antibiotic Therapy and Other Meds.
MIPS September, 2016 Nursing Home Population - Pneumonia, Urinary Tract Infection, Dehydration
- In relationship to cost, our major issue relates to post-acute care. This is a brief note about what that is. It is pleasing to note that these areas do not represent over utilization for personal aggrandizement. Another area of high utilization is in Hospice. The good news is that the only hospice which any SETMA providers have a formal relationship with has a “Cap rate” which is under the expected cost by a significant amount, once again demonstrating that no one is over utilizing for personal gain.
What is Post Acute Care?
- This link is to four power-point presentations on SETMA, Automation, Model of Care, MACRA and MIPS. Three were used in our October Provider Training Session and one was presented in a national webinar on October 26, 2016.
SETMA's Automation and Model-of-Care Preparation for MACRA and MIPS
- The following is a three-part series on SETMA’s Standards, automation, model-of-care and MACRA and MIPS. Published in local newspaper for introduction of the community to the changes in healthcare and giving SETMA’s response to those changes. These articles are taken from Four Categories Defined by MIPS Correlate with SETMA's Four Strategies for Transforming SETMA and Healthcare, which is seen in number 4 above.
James (Larry) Holly, M.D.
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