It seems that the news has spread like wildfire regarding the new methods of reimbursement that will be required by Centers for Medicare & Medicaid Services (CMS). But what exactly does it mean for you and the everyday running of your practice? As a busy healthcare professional, I am assuming you do not have the free time to skim through the 962 pages of MACRA and its proposed rulings. And knowing you do not have that leisure, I took the liberty of providing a quick 101 version to help test the waters in what could seem like an unfamiliar abyss.
CMS has finalized their Quality Payment Program after repealing the Medicare sustainable growth rate methodology or SRG. This is to be replaced with a new Merit-based Incentive Payment System (MIPS), which will update the physician fee schedule. Although MIPS is not set to begin until 2019, it is important to familiarize yourselves with the four performance categories within this system and how it will work for your practice.
Essentially, MIPS is a combination of three existing programs:
- Physician Quality Reporting System (PQRS)
- Physician Value-based Payment Modifier (VM)
- Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EP)
MIPS evaluates each MIPS eligible clinician (EC) based on a composite performance score across four performance categories:
Within the first year, Quality will consist of 50 percent of your overall score and is considered an adjusted version of the familiar PQRS. In this updated version, you will be selecting a total of 6 instead of 9 measures and there is more emphasis on outcomes.
Resource Use/Cost Category
This category will consist of 10 percent of your total score in the first year and it replaces VM. This category uses over 40 episode-specific measures to account for differences among specialties. This category focuses on patient volume, but CMS will calculate these measures based on claims and availability of sufficient volume. Clinicians do not need to report anything.
Clinical Practice Improvement Activities
In this category you can choose the activities best suited for your practice; the rule proposes over 90 activities from which to choose. Clinicians participating in medical homes earn full credit in this category, and those participating in Advanced APMs will earn at least half credit.
Advancing Care Information (formerly Meaningful Use)
In the updated version of Meaningful Use, you will report key measures of interoperability and information exchange. Here, you are rewarded for your performance on measures that matter most to you.
In addition to establishing MIPS, MACRA provides incentives for clinicians who are qualifying participants in advanced APMs that meet criteria specified in the law. The law further requires quality measures used in APMs, which the MDP is required to address, to be comparable to those used in MIPS. Intuitive Practice Success team can continue to take the liberty of providing you assistance, advice, and prepare your practice for this new system.