The 2,398-page final rule for the Medicare Access and CHIP Reauthorization Act (MACRA) was released in October. In the wake of this new ruling, a survey conducted by Medscape found that nearly 30 percent of physicians had never heard of MACRA as recently as mid-September. This seems like a large number of physicians who are still in the dark, considering that the law could positively or negatively affect their Medicare reimbursements by as much as nine percent.
Ophthalmologists, however, do need to be aware of MACRA and its ramifications on their practice operations and revenue, according to Jonathan Rubenstein, M.D., Director of Refractive Surgery at Rush University Medical Center in Chicago. Rubenstein told Medscape Medical News that MACRA is “especially important to Ophthalmologists,” since they “probably have the highest percentage of Medicare patients in any subspecialty” due to the high volume of aging patients they see.
In addition to the new guidelines it provides, MACRA includes two participation pathways—the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM). Without de-emphasizing the extensive and complex nature of the new law, the following list identifies three key points that Ophthalmologists need to know about the requirements of MACRA, MIPS and APM:
1. Quality is Crucial
Most Ophthalmologists will choose the MIPS route to report their MACRA-required data to Medicare, at least in the first year. In essence, MIPS is a combination of the Physician Quality Reporting System (PQRS), Meaningful Use (MU) and the Value-based Modifier.
Earning a payment bonus or penalty under MIPS is based on a 100-point Composite Performance Score, half of which is attributed to quality metrics. Unlike PQRS, however, physicians only have to report six quality metrics instead of nine. Ophthalmologists should ensure that their practice’s health information technology will automatically capture these chosen metrics and offer dashboards indicating their performance on the MIPS Composite Performance Score.
2. Patient Engagement is Essential
Although MU is being sunset into MIPS, it is not disappearing entirely. There are five required MU measures included in MIPS’s “advancing care information” section, including the patient engagement-related measures of “providing patient access” and “sending a summary of care” to the patient. Extra performance points can be earned with non-required measures like secure messaging and patient-specific education. In addition, MIPS contains a section stating that practices must report as many as six “clinical practice improvement activities,” choosing those activities from nine categories, including patient engagement, patient access and care coordination.
An integrated patient portal, secure patient messaging platform and automated appointment reminders will help Ophthalmologists ensure that they are sharing the required information with patients and are helping them stay engaged. Integration with the EMR and Practice Management system is essential to reduce manual data entry and maximize efficiency.
3. Certified EMR is Required
Ophthalmologists can earn a bonus point in the first year of the MIPS program for clinical improvement activities that utilize certified EMR technology, as well as for reporting to public health or clinical data registries. Starting in 2018, an EMR certified for 2015 will be required for MIPS compliance. This means it is imperative that Ophthalmologists be diligent with their vendor selections and choose a partner who will support them through all requirements of this game-changing program.
Certification is only one of many factors to look for when choosing an EMR. Ophthalmologists should seek out end-to-end technology solutions that are designed by a practicing Ophthalmologist and engineered to simulate their workflow for maximum productivity and efficiency. To learn more about end-to-end, ophthalmologist-specific EMRs and workflow solutions, click here.