Friday, October 28, 2016

Is Your Facility Ready for MACRA?

Yikes, another acronym! What is MACRA? It stands for Medicare Access and CHIP Re-authorization Act (MACRA) and is part of the Centers for Medicare sweeping payment reforms started in 2015. MACRA created the Quality Payment Program that rewards physicians and clinicians for giving better care, not just more care, and goes into effect in 2017.

How is MACRA different from Hospital Value-Based Purchasing?

The Hospital Value-Based Purchasing Program rewards acute care hospitals with incentive payments for the quality of care they give to people with Medicare. This program adjusts payments to hospitals under the Inpatient Prospective Payment System (IPPS) based on quality of care. MACRA is focused on improving the way physicians and clinicians are paid, to incentivize quality and value of care over quantity of services. Simply put,  HVBP focuses on the payments hospitals receive from CMS and MACRA focuses on payments physicians can receive from CMS. How does this affect you? Well if the majority of your physicians are hospital employees, then your facility must manage and account for both payment incentives in order to optimize your overall reimbursements from CMS.

Download our latest whitepaper - HOW WILL YOU RESPOND TO MACRA? Sweeping Changes to Physician Reimbursement and we will walk you through 3 ways your facility can prepare for MACRA.

#1. Educate Your Providers

It’s important that not only is your administration aware of the details surrounding MACRA, your providers should be too. Take the time to sit down with them to discuss how MACRA will affect them and how you can work together to maximize any and all reimbursements. MACRA will be implemented through a framework called the Quality Payment Program, which offers clinicians two paths for participation: The Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). Most Medicare participating physicians will initially utilize MIPS. The MIPS breakdown is shown below:

Data from HealthStream/Decision Health Whitepaper

50% of the MIPS score is based on quality. How does your organization define quality? Best practice is to get your providers involved in defining and setting the Quality goals that they will be measured on. Buy-in from both the clinical and administration teams will ensure success in meeting these new CMS payment programs.

#2. Identify and Track High-Performance Areas in Quality 

First, it's important as we discussed earlier to identify those quality measures you want to define as your high-performance areas. To help you do this CMS has outlined how they will score the Quality Performance category:

  • Each quality measure will receive a score of 1-10 points compared to an historical benchmark (if available). Zero points for a measure that is not reported
  • A bonus will be rewarded for reporting outcomes, patient experience, appropriate use of technology, patient safety and EHR reporting
  • Measures will be averaged to get a score for the category

As you can see they are looking for much of the same “quality” areas that are currently tied to the HVBP program including clinical outcomes, and patient safety.

Second, since your facility already has to comply with the Joint Commission's Ongoing and Focused Professional Practice Evaluation (OPPE and FPPE) regulations why not utilize this same reporting to track your MACRA quality measures.  A good OPPE analysis should provide a summary of how your physicians are meeting the specified clinical/patient safety outcomes with benchmarking, a measure of patience experience including CAHPS survey scores and provide a provider's social index which is an indicator of how the provider is viewed online in social media.

Example of an OPPE Analysis and a Provider Performance Profile Report

#3.  Review your Quality Resource and Use Report (QRUR)

The Quality and Resource Use Report (QRUR) shows how your payments under Medicare Part B fee-for-service (FFS) will be adjusted based on quality and cost. The report includes performance information from measures reported through the Physician Quality Reporting System (PQRS) and uses Medicare claims to calculate additional quality outcome measures and cost measures. Performance is compared to benchmarks of similar peer groups. Data in the QRUR is used by CMS to calculate your Value Based Payment Modifier (VBPM) and subsequent payment adjustments (positive, negative, or neutral).

Past QRURs can identify opportunities for improvement and also help you point to performance indicators that should be monitored and tracked with your OPPE analysis. Having your OPPE analysis and QRUR in sync can help you optimize your reimbursement payments for your providers and for the hospital as a whole.

Now that you know what MACRA is and how your facility can prepare for the changes, why not take the necessary steps to ensure your providers are in sync with the quality goals desired and that you have a good performance monitoring plan is in place. What to learn more? Click here.

1 comment:

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