Written by: Kelly Buckman
Speed, quality, and cost, three very important factors in healthcare today. One important advancement that helps ensure that quality doesn’t suffer in the effort to care for patients in a timely and cost efficient manner is an incentive program designed to accelerate the transition to value-based care.
Known as MACRA, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015. In a nutshell, MACRA:
-Repeals the Sustainable Growth Rate formula
-Changes the way that Medicare rewards clinicians for value - over volume
-Streamlines multiple quality programs under the new Merit -Based Incentive Payments System (MIPS)
-Gives bonus payments for participation in eligible alternative payment models (APMs)*
MACRA is rooted in the quest to improve healthcare through the sharing of health information. The most effective way to achieve this in today’s high tech world is through the electronic health record (EHR). Until relatively recently, providers have relied on paper records, fax transmission, or postal “snail” mail. Prescriptions were written on paper tablets and patient files were stored in file cabinets with data later entered into the system by a clerk or medical assistant proficient in healthcare data management.
The result was a fractured picture of a patient’s medical history, a system that was not conducive to sharing with other providers or with patients themselves for that matter.
As part of the Economic Stimulus developed during the Obama administration, a goal was set to transfer all patients’ health records into digital files or electronic health records (EHR) so that each doctor involved in the patient’s care could share vital information and work together to create a comprehensive healthcare plan.
Seems easy, right? But believe it or not, the healthcare industry in the U.S. was not quick to adopt this new technology. Old habits die hard, and healthcare providers would need an incentive to make the transition to electronic health records. So was born the concept of Meaningful Use. Under Meaningful Use, if healthcare providers implement EHRs, they can be partially reimbursed once they prove they have met certain criteria, the “Meaningful Use Rules”.
Meaningful Use
Meaningful Use has been implemented in stages: with Stage 1 focused on creating the information, Stage 2, exchanging health information, and Stage 3, dedicated to improving outcomes and requiring that all hospitals and eligible healthcare professionals use certified electronic health record (EHR) systems. Most importantly, the programs encouraged the adoption of new technology and gave eligible providers and hospitals incentives for using certified EHR technology to improve healthcare quality, safety, and efficiency.
Today, more than 97 percent of all hospitals and three-quarters of physician offices use EHRs, according to the Center for Medicare and Medicaid Services (CMS). Benefits of increased use of EHR include healthcare providers receiving a more accurate picture of a patient’s overall health, the ability to swiftly and safely transmit prescriptions electronically to pharmacies, patients having direct access to their health information, and more.**
MACRA
The next steps in implementing EHR technology involve transitioning from the staged Meaningful Use phase to MACRA, a program dedicated to achieving the full potential of health IT as a means of improving overall patient care. At the center of this bipartisan legislation is the desire to achieve truly patient-centered care by improving the relevancy and depth of Medicare’s quality-based payments.
MACRA replaces the Sustainable Growth fee-for-service approach that was clearly not working in today’s economy. Under the old approach, the more services a physician provided, the more money they would earn. Understandably, quantity too often took precedent over quality. By contrast, MACRA shifts the focus from volume to value. When a Physician provides a service, their payment is based on how well they meet certain quality measures and create value for their patients.
By focusing on key areas: Incentives, Care delivery, and information sharing, MACRA aims to achieve the following goals:
-Better care
-Smarter spending
-Healthier population
Under MACRA, care becomes increasingly focused and individualized, health information is more easily shared, and patients get healthier and stay healthier longer.
The incentive is significant. In 2019, there will be a 16% difference in income between high and low performing providers, and by 2022 that number could increase to 36%.
MIPS and APMs
MACRA requires that Healthcare providers choose one of two methods:
-Alternative Payment Models (APMs)
-Merit-Based Incentive Payment System (MIPS)
In 2017 (adjusted reimbursements in 2019), providers began receiving a MIPS score which will significantly change their Medicare reimbursement. Providers will be evaluated on 4 different categories to make up a 100 point MIPS score.
-Quality
-Resource Use
-EHR Use
-Clinical Improvement
Under MIPS, a provider’s reimbursements would be relative to the average performance score for all MIPS participants. For all physicians participating in MIPS, an official MIPS composite score will be listed online in the Physician Compare Portal, located on www.medicare.gov.
The alternative to MIPS is the APM or Alternative Payment Model, which gives added incentive payments for high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.
According to CMS, “an APM is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population. Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients’ outcomes.” In fact, providers can earn a 5% incentive payment in 2019 for Advanced APM participation in 2017 if they receive 25% of their Medicare Part B payments through an Advanced APM or see 20% of their Medicare patients through an Advanced APM.*
Note that if a physician does not qualify for APMs, they will automatically be enrolled in the MIPS model.
Please leave your questions or comments below. Or, if you would like to employ our our compliance or MIPS/ MACRA data submission services, or would like more information about MIPS, MACRA, APMS, Health IT, or any other related topic please contact us.
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Kelly Buckman is a healthcare IT expert and field expert blogger for Barracuda Consulting.
Kelly has almost a decade of experience as a Technical Support Engineer/ Analyst in the field of Healthcare IT, over 20 years in IT Support, and several years of experience in Project Management. She has a B.A. from Mount Holyoke, Masters degree from UMass Amherst, and lists her skills as the ability to analyze and resolve various types of application, server and network issues, and to communicate complex ideas effectively.
She is also the mother of 3 sons, ages 19, 17, and 11, lives in western Massachusetts, and enjoys solving puzzles, reading, and travelling.
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