2017 will be a big year for changes in payment models and you want your staff and practice to be prepared. The Medicare Sustainable Growth Rate reimbursement model was repealed by Congress one year ago. In its place, they have enacted the Medicare Access & CHIP Reauthorization Act (MACRA) and its payment system, Merit-Based Incentive Payment System (MIPS). These changes will impact Medicare payments starting in 2017.
In April, the medical community saw the first draft of the rules for MACRA. The intent of MACRA and MIPS is to provide flexibility for physicians to provide care for patients and to encourage the free flow of information across all areas of medicine.
To maximize reimbursement, practices will want to demonstrate an improvement in care, delivery, value, and efficiency of services, as well as the use of electronic health record keeping. Prepare your practice for the introduction of MACRA and MIPS by keeping these considerations in mind.
MIPS Focuses On Quality Care And Information Exchange
The goal of MIPS is to increase the use of technology in patient records, which in turn improves information flow, management, and ultimately the quality of care delivered. Health care providers will increasingly have to provide measured outcomes. No longer is it enough to simply say that the patient stated they feel better.
Reimbursement through MIPS will be based on a score of up to 100 quality measures. Quality of care and improved electronic records will be near 75% of the physician score. According to Healthcare Finance, the full breakdown is reported to be:
- Quality Measures - 30 percent
- Resource Use - 30 percent
- Clinical Practice Improvement Activities - 15 percent
- Meaningful Use - 25 percent
Physician practices will be bound to a performance threshold set by CMS, which will be the average performance scores of any eligible providers. Providers that perform below the assigned threshold will receive a negative adjustment, while those who perform above the threshold will earn a bonus. Your bottom line can be dramatically affected by bonuses and penalties, and the earlier your practice focuses on any necessary changes in procedures for the introduction of MIPS, the better your practice will fair.
Don’t Delay - MACRA And MIPS Timelines Are Set
CMS has very little flexibility for when to make the switch to MACRA. Due to legislative requirements, MACRA will begin January 1, 2017. That leaves your practice with only about 6 months to prepare for the changes to come.
Participants in MIPS are called Eligible Professionals (EPs) and as the years pass, more and more EPs will become involved. For the immediate future, 2017 and 2018, EPs will be limited to physicians, physicians assistants, clinical nurse specialists, nurse practitioners, and nurse anesthetists. In 2019, it is anticipated that EPs will branch out to include dieticians, clinical psychologists, physical and occupational therapists, speech and language pathologists, audiologists, clinical social workers, and nurse midwives.
Bottom line - the sooner you and your practice are prepared for the introduction of MACRA and MIPS, the smoother and easier the transition will be.
MIPS Was Designed Based On The Programs Already In Place
While MIPS is theoretically a new program, it was designed, in part, around programs already in use. It is likely that when the final report is published later this year, the quality measurements will resemble those in the Physician Quality Reporting System (PQRS) and Meaningful Use Program. Consequently, the practices that will benefit the most are those that report MIPS quality measurements through certified EHRs, as these measures will be meet the meaningful use component required.
Another component of MIPS, clinical practice improvement activities, will be introduced as a new measure later this year. It is anticipated that circumstances such as ease of access, patient safety and engagement, care coordination efficiency, and population health management will be measured and graded by MIPS. Those practices that are certified patient-centered medical homes (PCMHs) receive an automatic 15 points for the clinical practice improvement activities category.
Despite the changes that will come into play in 2017, there are a variety of similarities from current programs.
Not All Practices Will Benefit From The Transition To MIPS
Because of the way that MIPS is tied to performance, there will be winners and losers. MIPS was designed to be budget-neutral, meaning that the amount of money set aside for potential bonuses is the same as that set aside for penalties. Unless the practice achieves an absolute average, they will experience a bonus or a penalty. Small adjustments in yearly performance can have a dramatic impact on a small practice.
However, a benefit to all practices is that CMS has provided a significant amount of flexibility in reporting measurements. EPs are encouraged to report the measures that are most important and relevant to their specific practice. No longer will practices be forced to pigeonhole their practice into the strictly defined measures mandated in MU.
Practices that are proactive in the preparation for the implementation of MACRA and MIPS will have the greatest chance of success and growth. Understanding what changes are coming and how they will affect your practice and measurement goals can help your practice avoid penalties and reap the benefits of the new program.