MACRA/MIPS: Are you ready?

April 21, 2017 / By Mary Zeigle, MS

A recent survey in Healthcare Informatics  on physician readiness for implementing MACRA indicates a strong need for assistance and support.  The overall results of readiness of physicians polled show that 27 percent of the physicians felt “ready to go” while 73 percent needed help (of the 73 percent, 30 percent indicated they were “not at all prepared” and 43 percent were “well aware, but need help”).  I am reminded of the famous quote, “A journey of a thousand miles begins with one step” (Lao Tzu).  As daunting as the regulations seem, break it down, find your resources and start this value-based journey.

What is MACRA and MIPS?

Briefly, as there is a lot of information available on this topic including all of the regulatory details on the CMS website, MACRA is the Medicare Access and CHIP Reauthorization Act of 2015.  MIPS is the Merit-Based Incentive Program that defines the incentives and physician participation.

Why was it created?

MACRA was created to shift the burden of healthcare costs from fee-for-service to a value performance model with the goal of improving patient health outcomes and “flatten” the upward curve of Medicare expenditures.

How to start?

Establish an oversight team that includes administration, information technology (IT), physicians and other clinician representatives who will own the process and will work together to truly understand what is meaningful in caring for patients, what is working and what is not.  Supporting this team with dedicated time, medical record data (unstructured, structured), data analysts and skilled improvement specialists will aid in embedding this quality work into the culture of physician practice thereby setting a structure for on-going success.

The performance period began in January 2017, with payment adjustments to go into effect in 2019 based on the MIPS composite performance score.  Requirements are intended to “streamline the physician’s burden” by consolidating three programs: Physician Quality Reporting Program (PQRS), Value-Based Payment Modified (VM) and Medicare Electronic Health Records (EHR) Incentive Program into MIPS. 

Practices with experience in these existing programs (PQRS, VM, EHR) can use that experience to their advantage as the continuous improvement methods and quality tools used remain in play.  The Model for Improvement promoted by the Institute for Healthcare Improvement  is one such tool for implementing continuous improvement.

There are four categories comprising MIPS: 1) quality, 2) improvement activity, 3) advancing care information and 4) cost. Clinicians have options to scale their participation and submit data in the 2017 Transition year.  Data can be reported for:

  • a test period,
  • a partial 90 day period,
  • the full calendar year,
  • for participation in the Advanced APM (Alternative Payment Model) once the practice has been identified by CMS and specific requirements including potential risk-sharing are met, or
  • not reported (note: would receive the full negative 4 percent adjustment)

 A few links to excellent resources are provided below to get you started: 

  • American Medical Association: education, MACRA Assessment, downloadable action kit with checklist.
  • Quality Payment Program: fact sheets, guides, measure details, education webinar and tools.
  • Federal Register: Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models

Mary Zeigle, is a clinical analyst with the Clinical Terminology group at 3M Health Information Systems.