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Knowledge of the federal government’s MACRA/MIPS programs is essential to ensure you are compensated for the good work that you do. We go over some of the important facts that you need to know in this article.

What Is MACRA?

It stands for the Medicare Access and CHIP Reauthorization Act of 2015. The Act repealed the flawed SGR (sustainable growth rate) for Medicare that was used to calculate payment cuts for physicians.

MACRA rewards physicians for providing higher quality care with two tracks for payment:

  1. MIPS (a Merit-based Incentive Payment System), and
  2. AAPMs (Advanced Alternative Payment Models)

Why Is MACRA So Important?

According to the American Medical Association:

“Without the passage of MACRA, physicians could have been subjected to negative payment adjustments of 11% or more in 2019 as a result of the Meaningful Use (MU), Physician Quality Reporting System (PQRS) and value-based modifier (VBM) reporting programs—with even greater penalties in future years. In contrast, under MACRA, the largest penalty a physician can experience in 2019 is 4%.”

(Courtesy of the American Medical Association)

What Is MIPS?

The Merit-based Incentive Payment System (MIPS) consists of 4 performance categories:

  1. Quality – based on the Physician Quality Reporting System (PQRS)
  2. Cost – based on the Value-based Payment Modifier (VBPM)
  3. Promoting Interoperability (PI) – based on the Medicare EHR Incentive Program (Meaningful Use)
  4. Improvement Activities – a new category

Scores from these four categories are combined to establish a final score (0-100) that will be compared against a threshold.

The final score is used to determine your payment adjustments.

How Will You Be Scored Under MIPS?

Scores for each performance category will be weighted and rolled up into the MIPS final score. The weights of each category shift over the course of the program.

(Courtesy of the American Academy of Family Physicians)

Can You Participate In MIPS Without EHRs?

You can participate, but you won’t be eligible for any of the points under the PI performance category. And if your EHR isn’t certified, you’ll get a zero for this category.

Without EHRs, reporting requirements will be much more difficult to achieve. You would have to use a reporting method that involves claims or a qualified registry, and this would require a manual data collection on at least 60% of your eligible patients.

(Find out if your EHR is certified by going here: https://chpl.healthit.gov/#/search)

Why You Need EHRs For MACRA

According to the AMA, the role of EHRs in increasingly important under the MACRA. They are transforming the payment model and impacting the way you practice medicine.

Dr. McAneny, President of the American Medical Association tells us:

“Accounting for 25 percent of a practice’s Merit-based Incentive Payment System (MIPS) score, the Advancing Care Information (ACI) category replaces the former Medicare EHR Incentive Payment Program, commonly known as Meaningful Use.”

And according to the AMA:

“Following years of advocacy by the AMA, the Centers for Medicare and Medicaid Services (CMS) have removed the computerized physician order entry (CPOE) and clinical decision support (CDS) measures from the Medicare MU program and the ACI component of the Quality Payment Program (QPP).  However, the Medicaid MU program continues to include CPOE and CDS measures.

While CPOE and CDS functionality will still be included in EHRs, CMS will no longer require a certain number of orders, that a physician enter the orders, and that physicians implement a certain number of CDS tools. This means … physician practices are free to develop policies around CPOE and CDS in ways that blend with their workflows and improve care.”

What About AAPMs?

According to the AAFP, the AAPMs (Advanced Alternative Payment Models) available for primary care include:

  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program (MSSP) Tracks 2 and 3
  • Medicare Accountable Care Organization (ACO) Track 1+
  • Next Generation ACO Model
  • Vermont Medicare ACO initiative (as part of the Vermont All-Payer ACO Model)
  • Additional models will be announced by CMS as they are approved

For the 2018 performance period, an AAPM entity must do one of the following for all of its eligible clinicians to be qualifying participants (QPs):

  • Receive at least 25% of its Medicare Part B payments through the AAPM, or
  • See at least 20% of its Medicare patients through the AAPM.

Eligible clinicians that are not considered qualifying participants (QPs) can be considered partial QPs if the AAPM entity meets at least one of the following thresholds:

  • Receives at least 20% of its Medicare Part B payments through the AAPM, or
  • Sees at least 10% of its Medicare Part B patients through the AAPM.

The Importance Of Partnering With EHR Vendors

Barbara McAneny, MD of the AMA goes on to say:

“Many EHRs allow for the storage and management of charts, remote access to patient data and e-prescribing, but many widely available EHR platforms do not offer the flexibility to exchange data with or interpret data from other systems.

The medical community can contribute to the evolution of EHRs by partnering with vendors to improve EHRs, advocating for policymakers to develop effective health IT policy, and collaborating with physicians, institutions and health care systems to create effective institutional health IT policies.”

Click here to learn more about GDS and our efficient, compliant EHR software option – GDS ChartViewer.

In the meantime, contact the EHR/EMR Specialists at Global Data Systems for more information about how you can ensure interoperability between your EHRs and health IT systems.

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