X-Link Medical Software Interfacing Blog

MACRA & MIPS: Proposed Rule

Posted by The X-Link Team on Aug 26, 2016 6:13:40 PM

In April, as stated in the Health Affairs Blog, the Centers for Medicare and Medicaid Services (CMS) released the highly anticipated proposed rule that would establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These policies were established by the latest, permanent ‘doc fix,’ the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). http://bit.ly/1VEBbsb  @searchhealthit

MACRA MIPS interoperability interface hl7


Richard Royer, CEO of health IT consulting firm Primaris, spoke at the Health IT Summit conference in Boston in June. According to Mr. Royer, there are 10 things to know about the new healthcare law.  http://bit.ly/2btvjRe

  • Physicians will select from 300 clinical measures embedded in the MACRA rules, 80% of which are already in the Patient Quality Reporting System.
  • Providers should optimize their data and use metrics that measure medical outcomes.
  • Value-based care models are significantly data driven. So providers must not only continually measure, but also continually analyze patient health data, not just collect it
  • Care coordination will be a critical success factor in all types of quality measurement and alternative payment model programs under MACRA rules. Providers will need to communicate and coordinate with each other as patients with chronic conditions move from hospital to skilled nursing to long-term care to home health. Interoperability will be critical so providers can know how to share bundled payments.
  • Value-based reimbursement -- earning incentives and avoiding penalties -- is based on performance.
  • The Centers for Medicare and Medicaid Services can award extra bonuses to high-performing doctors and impose further penalties on low-performing ones.
  • Quality measurement, including such metrics as hospital readmissions and use of outpatient care settings, will start in January 2017 under MACRA rules.
  • Medicare payments based on quality measures will start being adjusted in January 2019.
  • There's a "take a break year" from quality measurement in 2018.
  • Population health is important because alternative payment models will use data and quality scores about populations of patients, not individual patients.

images_14.jpgCMS estimates that in 2019, the first year in which there will be a payment consequence for MIPS performance, $500 million in “exceptional performance payments” will be distributed to eligible clinicians.  Further, the agency will make around $200 million in APM incentive payments that year. #macra #mips

Even though the final MACRA rule is not expected until November 1, 2016, you should probably start putting an action plan in place now. New Macra rules are proposed to begin on January 1, 2017, just 2 months after the expected release of the Final Rule—not much time to prepare. There are things you can do to start planning your strategy and improve your chances of success.

1.    Focus on PQRS reporting: Reporting carries a 50% weighting next year, which makes it the most important of the 4 MIPs performance targets, (the others being Advancing Care Information, aka MU; Clinical Practice Improvement Activities; and Resource use, aka cost). Take full advantage of the next 4 months to improve your quality measure workflow and reporting.

2.    Decide if you want to report MIPS as individual physicians or as a group:  Look at your practice’s current MU and PQRS performance as a predictor of which option might be more beneficial. 

3.    Develop workflows to support success: Identify the ACI patient engagement and health information exchange (HIE) measures that are of most interest or relevance to your practice. Use that information to try to enhance the workflows that support these measures.

4.    Review the list of Clinical Practice Improvement Activities: Review the list provided in Table H of the Proposed Rule. Are there activities that fit your practice or possibly some that you were considering, even before MACRA?

5.    Evaluate your current technology resources:  If you are not satisfied with any part of your current technology, now is the time to make changes, particularly when you use it to meet the government requirements? Easy Business Software would be happy to review your system and help you decide if changes need to be made.  Keep yourself educated and don't let those deadlines catch you off guard. Being prepared will make this process easier.

Comment and let us know your preparedness plans for MACRA and MIPS!

Topics: Interoperability

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Welcome to the X-Link blog! Here, you can find a wealth of information on everything within the healthcare sphere! Each week, the X-Link Team will inform you of industry trends, share multiple perspectives, and give objective advice on topics such as...

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