The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a major piece of legislation that contains two value-based care programs that will affect nearly all physicians: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM).
The upcoming change in presidential administration has brought about some persistent myths about MACRA, MIPS and APM, five of which we will debunk here. Rather than believe these myths, practices should prepare to make the most of MIPS and APM in 2017 to achieve the maximum incentive before the first full year of reporting is required in 2018.
Myth #1: Trump is repealing Obamacare, which will end MACRA
Fact: The Patient Protection and Affordable Care and Accountability Act (i.e., "Obamacare") and MACRA are separate laws.
MACRA ended the Sustainable Growth Rate program with large bipartisan support, and there are strong indications that Trump will continue the industry’s transition to value-based care.
Myth #2: MACRA will replace the Physician Quality Reporting System and Meaningful Use
Fact: MIPS combines many elements of Physician Quality Reporting System (PQRS), Meaningful Use (MU) and the Value-based Modifier (VBM) programs into three separate required components, while adding a new fourth section.
The Quality component replaces PQRS and includes many of the same metrics that providers need to capture, while the Advancing Care Information (ACI) program replaces MU and eliminates some requirements from the legacy program. The Cost component of MIPS replaces the VBM and is based solely on the provider’s Medicare claims. Clinical Practice Improvement Activities (CPIA) is a new MIPS initiative that rewards practices for embracing initiatives to improve care quality or reduce costs.
Myth #3: I do not have to participate in MIPS
Fact: Most physicians and advanced practice providers—including nurse practitioners and physician assistants—must participate. There are three exemptions:
1. 2017 is the first year of the provider’s Medicare participation
2. The provider collects $30,000 or less in Medicare charges
3. The provider is participating in an APM program, such as the Medicare Shared Savings Program (This exemption seems to be leading providers to believe Myth #4.)
Myth #4: I am in an Accountable Care Organization (ACO), so I do not have to participate in MIPS
Fact: The CMS definition of an APM is narrow, so many ACOs will not qualify for exemption under the criteria.
ACO members need to report quality measures and utilize a certified EMR, and the practice will want to protect its providers if the ACO fails to report. As a backup plan, ACO providers who work in a practice setting should capture all of the necessary quality metrics and other information in case a MIPS report is required.
Myth #5: I will not need a new EMR until 2018
Fact: This is technically true, but choosing not to prepare in 2017 and waiting until the last minute could create problems in 2018. In addition, MIPS has easier requirements in 2017 and offers a financial incentive for reporting the full year of data.
Prepare now to get a head start on MACRA success
The first step in preparing for MIPS and APM requirements in 2017 is to ensure that your EMR is certified for all measures and that the EMR vendor has a path to certification for its next edition.
Sign up for and integrate a clinical data registry—or a qualified clinical data registry (QCDR), if available—to facilitate the reporting process. These registries can collect and submit PQRS quality measure data on your behalf. Ophthalmologists will want to sign up for IRIS Registry, Dermatologists should sign up for DataDerm, Plastic Surgeons for ASPS-QCDR, and Otolaryngologists for Regent. Integration is the easiest way to achieve the Quality component requirements, as well as portions of the ACI and CPIA sections.
With some preparation, providers can maximize financial incentives in 2017 rather than leaving money on the table.
Want to know more about MACRA’s short- and long-term financial incentives, as well as penalties for non-participation? Read 3 Steps to Start Earning MACRA Financial Incentives in 2017.