Friday, December 2, 2016

How to Educate Your Providers About MACRA



Guest Post by Dawn Anderson, Product Manager - Medical Group Credentialing & Provider Enrollment; Echo, A HealthStream Company


CMS estimates that between 592,119 to 642,119 clinicians will be affected by MACRA (The Medicare Access and CHIP Reauthorization Act) rule changes that go into effect in 2017. Despite this fact a recent Medscape study found that 28.6% of the physicians that responded to their recent survey said they had not heard of MACRA and an additional 39.2% said they did not know a lot about it. Providers need to be educated about MACRA.

Download our latest whitepaper - HOW WILL YOU RESPOND TO MACRA? Sweeping Changes to Physician Reimbursement and we will walk you through a few things that your providers should know.

The Medicare Access and CHIP Reauthorization Act (MACRA) rule changes go into effect in 2017 with the first payment adjustments taking place in 2019. MACRA has two tracks: Advanced Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS); CMS estimates that only 4 to 11 percent of clinicians will qualify for advanced APMS according to a recent report by the Brookings Institute. This means that most clinicians will fall under the Merit-Based Incentive Payment System (MIPS). MIPs does not apply to hospitals or facilities. CMS recently announced that it will give physicians 4 MACRA options for 2017 that would let them choose how quickly they want to implement MACRA and each option would avoid a penalty in 2019.

MACRA Options


Option #1 allows physicians in the Merit-Based Incentive Payment System (MIPS) to avoid a penalty in 2019 by reporting “some” quality and cost data in 2017, rather than all the data required under MACRA’s Quality Payment Program (QPP).

Option #2 allows physicians in MIPSS to submit the required quality and cost data for just part of 2017. The performance period would not need to begin on January 1, 2017. Physicians exercising this option not only avoid a penalty, but also could potentially earn a modest bonus in 2019.

Option #3 involves submitting performance data for the entire calendar year of 2017, which was the original goal of MACRA. This option allows for the potential of earning a higher bonus in 2019.

Option #4 is to join an Advanced Alternative Payment Model (APM), such as an Accountable Care Organization (ACO).

How will MACRA Affect Your Providers?


MACRA applies to clinicians, not just physicians. MACRA will apply to nurse practitioners, physician assistants, clinical nurse specialists and nurse anesthetists including those in your practice. In the third year, the list will expand to include physical and occupational therapists, nurse-midwives, clinical social workers and clinical psychologists.

MACRA will require outcome reporting. At least one outcome measurement must be tracked for MIPS. Being held accounting for outcomes is becoming an important part in quality assessments. Medicare’s Physician Quality Reporting System (PQRS) already requires doctors to report process measures, for example the percentage of patients with coronary artery disease for whom the physician has prescribed aspirin. The PQRS also allows physicians to select from a small number of outcome measures, but they are not required to select or report on outcome measures.

Next year, under MACRA, PQRS will be replaced by the quality performance (QP) category of the Merit-Based Incentive Payment System, MIPS and physicians will have to choose one quality measure out of a total of six measures to report.

Under MACRA payment is related to patient outcomes. MACRA represents a new way of allotting Medicare Part B payments to clinicians based on patient outcomes rather than quality of services. The MIPS model is budget-neutral with penalty payments for low performers paying for the bonuses for high performers. This means that about half of the participants in MIPs will get a penalty and the other half will get a bonus, and it also means that some clinicians could pay a penalty even if their performance is good, but not exceptional.

A New Toolkit for Educating Providers


The American Medical Association (AMA) has created new online tools for MACRA that walk clinicians and their staff through the details of MACRA, called StepsForward. These tools include a payment model evaluator that projects whether the clinicians will default to the MIPS program and can estimate if they will receive a bonus or a penalty in 2019. The tool points them to educational tools and resources to help them improve those predicted outcomes.

According to the AMA, StepsForward is a practice-based initiative with a goal to provide proven strategies that can improve practice efficiency and help clinicians reach better patient experience, better population health and lower overall cost with improved professional satisfaction.

At a press conference on October 5, AMA President Andrew Gurman, MD, said some modules could even satisfy practice-improvement requirements in MIPS.

The AMA is also offering a podcast series on ReachMD titled “Inside Medicare's New Payment System”. Speakers include none other than CMS Administrator Andy Slavitt. Future episodes will keep providers apprised of changes to MACRA as the program goes forward.

MACRA is rapidly moving forward, so why not take the necessary steps to educate yourself and your providers to prepare for the coming changes. What to learn more about our Revenue Cycle Management solutions? Click here.

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