Signed into law in 2015, Medicare Access and CHIP Reauthorization Act, also known as MACRA, is coming into play. Although 2019 will be the first year that MACRA payment will be implemented, 2017 is MACRA’s base year, so the time to prepare is now. Changes in healthcare may seem daunting, but don’t run under a rock at the first mention of MACRA. Instead, learn what it is, what it means, and how to prepare.
What is changing?
Created in 1997, the Sustainable Growth Rate (SGR) formula is being replaced for a system that values and aims to prioritize quality over quantity. In place of Medicare’s physician quality reporting programs, a Merit-Based Incentive Payment System (MIPS) will be put into place. The goal is to have a single program that gives flexibility to physicians, reimbursing them based on four factors.
What is not changing?
Hospitals will not be impacted. In addition, some programs such as Accountable Care Organizations (ACOs), bundled payments, and some other value-based models will be preserved.
1. Evaluate your performance under Medicare’s quality programs.
Low-volume exemptions may be given to those who are in their first year as a Medicare provider, those who have less than $30,000 in Medicare charges or fewer than 100 unique Medicare patients per year. Physicians can pick to participate in MIPS as individuals or as a collective, but it is important to keep in mind that those who decide to participate as a group will be judged on all four performance categories as a group. How well your group performs indicates how much Medicare payments will increase or be cut by 2022.
2. Decide between a MIPS track or an APMs track.
MIPS will be the standard system used. If physicians pick this option, they will see a payment increase or reduction based on a performance score measured by the following four factors:
- Quality (50%)
Chose six measures to submit.
- Cost of resource use (10%)
This is calculated by CMS by comparing resources used to treat similar care processes across practices
- Advancing care information (25%)
Evaluation of security and interoperability
- Clinical practice improvement activities (15%)
Broken down into categories such as patient access, care coordination, and more.
APMs reimburses Medicare providers based on the value of services. Advanced APM must require:
- EHR technology
- Payment based on quality measures
- A financial risk or a medical home that meets certain criteria
3. Outline a strategy for approaching MACRA.
MACRA reporting begins January of 2017 so if you haven’t already, it is time to get moving on a roadmap. After deciding which route to take, break down how to get there by identifying the main players, leaders, connecting with any helpful personnel or resources and keeping track of all progress.
4. Connect with your EHR vendor.
If EHR is already a part of your system, be sure that the product will be upgraded and certified for MACRA. If you are not using an EHR system yet, you will need to find one that works for you and implement it. When considering the MIPS track, make sure your computers and servers are able to handle that amount of data. Upgrades should be considered.
5. Schedule meetings to educate providers and discuss new regulations.
Did you know that groups can be rewarded for reporting data? Under MIPS, pay cuts may be given based on performance in comparison to other groups. Getting a head start and educating providers early on about these MACRA changes may help the process progress considerably. Make certain that they understand the role they play in the group’s representation and that their scores will be compared and published publically.
6. Recognize any potential penalties.
Keeping monthly updates and notes on progress will allow a better understanding of where you are and where you need to go. Being aware of any potential penalties puts you ahead of the game.
7. Team up.
In some cases, smaller groups may benefit from partnering with an IPA (independent practice association), PHO (physician-hospital organization), CIN (clinically integrated network), or ACO. Teaming up can lead to further management possibilities. If your medical group has a PCMH (patient-centered medical home) status, you could receive full credit.
8. Implement change.
Undergoing changes that comply to MACRA is no small feat. Assembling a strategy and a team that can drive the mission forward will help the process immensely. Although change leadership is not necessary to implementing change, it can help to keep the team on track, organize, explain, and lead the process to completion.
9.Find meetings and resources.
Some physician groups such as the American Medical Association and the American Academy of Family Physicians offer training and help for physicians switching to MACRA. For online help, check out the American Hospital Association.
Sarah Lisovich is a Chicago-based Health IT strategist at CIA Medical. With over twenty years’ association with various health care IT venders and the impact of various systems on medical practices, Ms. Lisovich explores the revolutionary world of healthcare technology in the hope of opening doors to those interested in the field by building an online community.