July 2nd, 2019
Quick Review of MACRA
In 2015, MACRA, the Medicare Access and CHIP Reauthorization Act created the Quality Payment Program (QPP) and transformed the Medicare physician payment system from one based on volume to one based on value.
QPP has two tracks:
- Merit-Based Incentive Program (MIPS)
- Advanced Alternative Payment Models (APMs)
How you score against a 100-point performance scale will determine your Medicare Part B service payments. The categories assessed are Cost, Quality, Promoting Interoperability (formerly known as Advancing Care Information), Improvement Activities, and Complex Patient Bonus.
Since 2015, MACRA has been refined and updated. Late in 2018, the U.S. Centers for Medicare and Medicaid (CMS) released the final rules governing the Medicare QPP.
Easily Digestible Highlights
Keeping up with government mandates can be a challenge. You’ve got a practice to run and patients to see. So, we’ve summarized what you need to know in 10 easy bites. Don’t have a lot of time to read? We understand. So, we’ve broken it down into two short articles. Get started with the first five things you need to know about the latest and final MACRA ruling. Then check back next week for the next five things.
1. New category weights
There are changes to two of the four performance categories that make up the score determining your payment adjustment.
- Cost will increase from 10% to 15%
- Quality will decrease from 50% to 45%
- Promoting Interoperability stays at 25%
- Improvement Activities stays at 15%
2. Revised Quality measures
To help keep the focus on outcomes, CMS removed 26 MIPS Quality measures that were difficult to measure in a meaningfully way. Eight new measures have been added.
Reporting claims-based measures will be allowed for clinicians in practices of 15 or fewer clinicians.
3. Restructured Promoting Interoperability (PI) measures
CMS is shifting to a smaller set of PI measures, with scoring based on your performance for that measure. And, CMS has changed the requirements for patient engagement to measure areas in which the provider has more control. For example, patients don’t have to log into the clinician’s portal for the clinician to meet the requirements.
PI measures will fall under these four objectives:
- Electronic Prescribing
- Health Information Exchange
- Provider to Patient Exchange
- Clinical Data Exchange
Unless you are eligible for an exclusion, you must report certain measures under each objective.
Two new optional measures will be added for E-Prescribing: Query of Prescription Drug Monitoring Program and Verify Opioid Treatment Agreement, with bonus points available.
4. Higher payment adjustments
If eligible, your MIPS performance will decide whether you receive a positive or negative adjustment of 7% on your Medicare reimbursements going forward, up from 5% in 2018 and 4% in 2017.
5. New performance thresholds
CMS is doubling the MIPS performance threshold in 2019 from 15 to 30 points needed to ensure a neutral payment adjustment.
More to Come
Stay tuned for Part 2 of MACRA updates.