B R O U G H T T O Y O U B Y

:

WHITEPAPER

BY KEN TERRY

ewer than half of
physicians are
aware of the
Medicare Access &
CHIP Reauthorization Act (MACRA), and
most of those who do know about
it probably wish it would go away.
Nevertheless, this law will determine how Medicare reimburses
doctors, starting in 2019.
Although the Centers for
Medicare & Medicaid Services
(CMS) won’t release its final
MACRA rule until later this fall,
CMS recently changed the timeline for measuring the performance of physicians on quality,
cost and other parameters. This
1

modification will make things
considerably easier for doctors,
but they should still start getting
ready for MACRA immediately,
experts say.
Under CMS’ original proposal, physicians would have had
to report on their performance
for a full calendar year, starting
January 1, 2017. The fee for
service Medicare income of most
physicians would be adjusted up
or down 4% in 2019, depending on their scores. The at-risk
portion of their Medicare reimbursement would rise to plus or
minus 9% by 2022.
The new CMS policy gives
physicians more flexibility to

A sponsored Medical Economics whitepaper

adjust to this new reimbursement
approach. In the first option,
physicians who submit at least
some data to CMS’ new Quality
Payment Program in 2017 will
not be financially penalized in
2019. In option two, doctors can
start submitting the full range of
data required by CMS anytime
in 2017 and qualify for a partial
bonus if they do well. In option
three, practices can submit data
for the full calendar year and
qualify for full bonuses, again
assuming that they do better than
average on the measures.
These three options are
designed for physicians who
elect to go into the Merit-Based

” he stated. CMS will allow practices to use their current certified EHRs until 2018. such as engaging in population health management. But the percentage of income that a practice could gain or lose will quickly grow. To support clients in preparing for MIPS. Otherwise. he notes.000 practices that will participate in CMS’ new Comprehen- Physicians who don’t participate in the Quality Payment Program will automatically get the full downward adjustments in their reimbursement rate in 2019. however. “I see MIPS as just training wheels. If a practice’s EHR is upgraded by January 1. when they must switch over to EHRs that meet different certification standards. which include certain accountable care organizations (ACOs) and the 5. The fourth option is to apply for recognition as one of MACRA’s Alternative Payment Models (APMs). which won’t be described in detail until the final rule is issued. at least temporarily. the practice can report with minimal difficulty if it chooses the full-year reporting option. the vendors won’t have to sprint to meet the January 1 deadline. tronic health records (EHRs) or upgrades or hire additional staff to meet the MIPS criteria. Doctors in APMs will automatically receive 5% annual bonuses for five years. which must take on a significant amount of financial risk for care delivery. WHAT YOU NEED TO DO NOW Practices should immediately consult with their EHR vendors to find out when their products will be ready for MIPS. If a practice receives a downward payment adjustment.Incentive System (MIPS). David Wofford. rather than invest in new elec- ALTHOUGH PRACTICES MAY NOT SEE AN IMMEDIATE ROI. athenahealth partners with practices of all sizes to help ensure MIPS success. a San Diego- MIPS Guarantee from athenahealth’s network-enabled services help practices thrive through change. No more than 10% of physicians are expected to participate in APMs. starting in 2019. While awaiting the EHR updates.” Here’s how to navigate these challenges both now and in the future. THE PERCENTAGE OF INCOME A PRACTICE COULD GAIN IS SIGNIFICANT AND THE AMOUNT THEY COULD LOSE COULD BE EVEN MORE PROBLEMATIC. acknowledges that practices are unlikely to see an immediate return on such investments with only 4% of Medicare revenue at risk in MIPS. But the current EHRs were not programmed to work with the MIPS quality measures. the practice might want to wait until it receives the upgrade before beginning to report. Nevertheless. some doctors might be inclined to take the hit on their Medicare income. athenahealth guarantees that new clients using its services will avoid any MIPS payment penalties in 2019 based on 2017 performance. athenahealth incorporates quality measures directly into a practice’s workflow to help clients meet requirements without additional work. So EHR vendors will have to tweak their products to calculate those measures. With the greater flexibility that CMS recently introduced to the rules. and the program might evolve into something more problematic for those who don’t participate now. sive Primary Care Plus demonstration. “They’re preparing us for something else— some kind of expanded risk. 2 A sponsored Medical Economics whitepaper based consultant with ECG Management Consultants. the company promises to credit the client the amount of the penalty for the 2017 reporting period. They might also not want to invest in MIPS-mandated clinical practice improvement activities. practices should carefully evaluate their systems to see how they can be used to support . one of two tracks in the Quality Payment Program. The latter EHRs are not yet available.

. For example. They can also send out automated phone or email reminders to let patients know that they are overdue for recommended care. QRURs can help physicians see where they stand on quality measures compared to their colleagues. CHOOSING MEASURES A physician’s MIPS score represents his or her comparative performance in four categories: quality (50%). also of ECG Management Consultants. Since quality measures comprise half of the score. Nevertheless. Some EHR suppliers help practices select the measures that they’re best suited for. physicians should be able to see how their performance compares whenever they want. and regional healthcare collaboratives. To improve quality scores. These include the use of special procedure codes. physicians need both historical data on their patient populations and near-real-time data on the services they’re providing—or not providing—to their patients. experts emphasize the importance of excelling in that area. They suggest choosing metrics that the practice has done well on in the PQRS program. There are ways to obtain comparative data that is more usable than what QRURs offer. says Krista Teske. so the data in them is not timely. For instance. To improve performance on quality measures. Groups can also report their quality data to CMS through qualified clinical data registries SINCE QUALITY MEASURES COMPRISE HALF OF THE SCORE. Practices can then alert doctors that they need to provide those services when these patients visit. Groups should also choose some measures that cut across specialties. practices should use the patient registries built into their EHRs. Practices that have submitted data to the Physician Quality Reporting System (PQRS) can access Quality and Resource Use Reports (QRURs) on CMS’ web portal. 3 (QCDRs) that are provided by specialty societies. meaningful use of EHRs (25%). and they regard the selection of the right quality measures as the key to success. clinical quality improvement activities (15%). but there are other information sources that can be valuable. Besides sending alerts and reminders to providers at the point of care. AND THEY REGARD THE SELECTION OF THE RIGHT QUALITY MEASURES AS THE KEY TO SUCCESS. especially those on which their performance exceeds that of their peers. doctors need benchmarking data to see how they stack up with their peers in MIPS. CMS will allow practices to report quality data using any of the methods they have employed to report to PQRS. A PHYSICIAN’S MIPS SCORE REPRESENTS HIS OR HER COMPARATIVE PERFORMANCE IN FOUR CATEGORIES: 50% 25% 15% 10% QUALITY MEANINGFUL USE OF EHRs A sponsored Medical Economics whitepaper CLINICAL QUALITY COST IMPROVEMENT ACTIVITIES .C. these registries can also be used to run reports on which subsets of patients have not received certain types of preventive and chronic care. If they decided to switch EHRs. Much of that data will come from EHRs.MIPS. under the new MIPS rules they’d have a large part of next year to choose another system and implement it. Wofford says. certification boards. they might decide that their current EHR will not provide them with the capabilities they will need for MIPS going forward. If practices do that. consulting firm. D. a consultant with The Advisory Board Company. Some cloud-based EHR vendors offer benchmarking services based on their customers’ data. and cost (10%). EXPERTS EMPHASIZE THE IMPORTANCE OF EXCELLING IN THAT AREA. These reports are annual. a Washington. which will increase the completeness of their data. Teske notes. says Erin Mastagni. direct EHR reporting.

. says Teske. or the hiring of an onsite diabetes educator.qualified registries. a healthcare consultant in Mechanicsburg. and delivering test results in a timely manner. and select the right quality measures. resource use comprises only 10% of the MIPS score. but that percentage is expected to rise. But it shouldn’t be a big challenge in 2017 if they 4 and weekend hours. practices will have to exceed the average ranking. Teske recommends that independent practices focus on reducing hospitalizations to improve their utilization scores. and doctors will get 50% of the points just for reporting. not just when it’s time to report. In the near term. The resource use section doesn’t require reporting. Teske points out that it may become more difficult to do it this way in MIPS. While claims-based reporting is still the most common method. and migrating toward those because of the data completeness component. Some of these CPIAs will require a substantial investment. ACI’s objectives encompass data security. Graduated scoring will replace the pass/ fail Meaningful Use approach. and QCDRs.” she says. they will have more stringent requirements based on stage 3 metrics. to cover the costs of practice transformations A sponsored Medical Economics whitepaper that will help them with CPIAs and other MIPS criteria. CONCLUSION Even small practices can tackle MIPS successfully if they prepare and have the right technology partners. That is because the percentage of Medicare patients on which practices must report for a particular measure will rise from 50% to 80%. an EHR supplier should be able to ease the burden of data collection. expanded practice access might include increased evening AS THEY CHOOSE A PARTNER. reporting and feedback. use of telehealth services. Ultimately. improving communications with patients. collection of patient experience data and a plan for improvement. The American Academy of Family Physicians (AAFP) suggests that physicians consider using Medicare’s Chronic Care Management Program. They should be trying to transform themselves so they can raise their performance scores. which pays $40 per patient per month for enhanced care management. Wofford notes. MEANINGFUL USE SUCCESSOR The successor to Meaningful Use. patient electronic access. For example. In some cases. and health information exchange. coordination of care. while others may be things a practice is already doing. a practice can use its quality measurement efforts to meet CPIA requirements. The clinical practice improvement activities (CPIA) section requires changes in practice operations. They could also be careful not to over-order diagnostic tests. To do well on ACI. Right now. will include 11 measures of EHR use that have been modified from the Meaningful Use Stage 2 criteria. and the proactive practices are more likely to be winners. the practice should make sure this company is focused on helping it generate high MIPS scores without too much exertion. practices should stay in touch with their EHR vendor. As they choose a partner. called Advancing Care Information (ACI). Groups of 25 or more eligible clinicians may also use a CMS web interface for reporting. For example. notes David Zetter. observe what comes out of the final rule. because CMS will use Medicare claims data to measure utilization. urgent care access. they should keep trying to improve and should work at it all year round. In the long run. Practices can choose among 90 activities as diverse as expanding access to the practice. there will be winners and losers under MACRA. “Groups should be evaluating other EHRbased and QCDR mechanisms have already met the stage 2 requirements. Practices that want to succeed in a value-based environment should not just look at the short-term ROI from MIPS. he says. THE PRACTICE SHOULD MAKE SURE THIS COMPANY IS FOCUSED ON HELPING IT GENERATE HIGH MIPS SCORES WITHOUT TOO MUCH EXERTION. Pennsylvania. In 2018.