Breaking down the MACRA Composite Performance Score

What is the CPS, and how might anesthesia providers’ Medicare reimbursements be adjusted based on MACRA compliance?

The 2018 MACRA program consists of 4 categories that are weighted differently to calculate a Composite Performance Score for a given NPI/TIN combination:

  • Quality Measures
  • Improvement Activities
  • Cost
  • Promoting Interoperability

The Composite Performance Score & The Anesthesia Providers’ Adjustment

The figure above demonstrates how the eligible anesthesia provider’s composite performance score will impact her Medicare reimbursements.

Let’s break this down a little bit:

The Negative Adjustment Factor

The red area is called the Negative Adjustment Factor. In 2017, the negative adjustment factor actually stopped at -4.0%, while in 2018 it grows to -5.0% and even further in 2019.

The Positive Adjustment Factor

The dark green area…The higher your Composite Performance Score (CPS), ranging from 0-100, the higher your positive payment adjustment is going to be.

Additional Adjustment

You’ll notice the light-green area of the chart that appears when the CPS climbs over 70. This is a special pool of money – $500 million- that is put aside every year for providers who are determined to be “Exceptional Performers.” Providers receive that designation when they achieve a CPS of 70 or above. Similar to the Positive Adjustment Factor, the Additional Adjustment increases in proportion to the CPS.

A Hidden Challenge

Part of what makes this whole idea challenging is that, per the federal government, the red and the dark green areas must be budget neutral. The pool of money available for providers who earn a positive adjustment is created from the penalized non-compliant providers whose reimbursements are negatively adjusted. The effect is that nobody knows quite how important the Positive Adjustment Factor is going to be until after the reporting year has ended. Figure 1 shows a Positive Adjustment Factor of 1%, but that may or may not reflect the actual adjustment that is available. Similarly, no one can accurately predict Additional Adjustment effects until all Eligible Providers (EPs) have completed their submissions at the end of the reporting period. The chart does accurately demonstrate a gradual increase in adjustment is available as your CPS improves.

Additional Resources

This gives you a little snapshot, but as you can see, there are a ton of details and implications in the MACRA compliance world. Graphium Health has been working for the last few years to help anesthesia providers understand compliance and get the highest possible Composite Performance Score.

If you have any questions at all, we have great resources for you:

MACRA Compliance For Anesthesia: Lessons Learned