As MACRA replaces Medicare reimbursement with a physician pay-for-performance program, accountability will reign…whether you’re ready or not.
In an online educational session, Debra Harris, AdvancedMD Senior Product Manager & Regulatory Specialist, emphasized this accountability through the new Merit-based Incentive Payment System, or MIPS, which replaces Meaningful Use and links payments with value and quality.
As early as next year, MACRA will combine three programs: the Physician Quality Reporting Program (PQRS), Value-Based Payment Modifier, and Medicare EHR Incentive Program into one, streamlining MIPS. A composite performance score will be based on these four weighted performance categories for 2017:
- Quality (PQRS): 50 percent
- Resource Use/ Cost (Value-based modifier): 10 percent
- CPIA: Clinical Practice Improvement Activities (a new category): 15 percent
- ACI: Advancing Care Information (formerly Meaningful Use): 25 percent
Quality. Practices will provide information on the quality of care by focusing on measures of their choosing for reporting. They may select individual measures or specialty measure sets from more than 300 measures, including one cross-cutting measure for patient-facing clinicians and one outcome measure. As with PQRS, practices are providing information on quality of care, but only six measures will be required as opposed to nine.
Resource Use / Cost. Practices will treat patients as usual, and CMS will calculate measures based on the date of service for the visit. Some of the proposed measures include more than 40 episode-specific measures, while two measures examine overall resource use—accounting for all Part A and Part B Medicare spending for primary care physicians—and spending around hospitalizations.
Clinical Practice Improvement Activities. Points for CPIA are earned on PCMH (Patient-Centered Medical Home) or comparable specialty practice participation, Alternative Payment Model (APM) participation and other improvement activities. Practices receive 100 percent credit—meaning the full 15 percent for the CPIA category—by being a PCMH participant. APM credits are available, as well. There are more than 90 activities available if you are not a PCMH or APM participant, with a minimum of one activity required. These will be discussed in more detail during our MIPS: CPIA & Resource Categories webinar scheduled on Aug. 11. Activity categories include expanded practice access, population management, care coordination, and beneficiary engagement.
Advancing Care Information. The ACI category replaces Meaningful Use. In ACI, there’s an emphasis on patient engagement, interoperability and security. The Meaningful Use objectives demonstrated in the past are reduced to 6 objectives:
- Protect patient health information
- Electronic prescribing
- Patient electronic access
- Coordination of care through patient engagement
- Health information exchange
- Public health and clinical data registry reporting
ACI composite scoring is more complex than other performance categories with a base score, performance score, and bonus points. This will be explored in more detail during the July 22 webinar, MIPS: Quality & ACI Categories.
Learn all you need to know about MACRA by signing up for AdvancedMD MACRA webinar series and through our blog posts. We strive to help you navigate the regulatory environment and receive well-deserved rewards for delivering high-quality care to patients.
