In recent years, providers and practice groups have been worrying about Meaningful Use (MU) and gaining knowledge on using certified electronic health record (EHR) technology to avoid payment penalties, earn incentives and increase practice efficiency. Now, with the release of the final rule for MACRA payment reform, physicians will have two options for payment paths: the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). On Jan. 1, 2017, the start of the reporting year, MACRA went into effect, replacing the Sustainable Growth Rate formula. This system will continue through Dec. 31, 2026. In 2018, physicians can potentially expect another transition year of reporting and, in 2019, benchmarks and reporting will start to substantially affect reimbursements.
MIPS consolidates different programs and regulations, such as the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier and MU, which was renamed to Advancing Care Information (ACI), along with the new requirements of showing clinical practice improvement activities in an effort to simplify reporting and to achieve goals that primarily include improving health outcomes for patients. Practices should be aware that PQRS does and will ultimately tie into MIPS. But the CMS will look at specific key clinical practice activities, and these activities will be the measures and/or key performance indicators that providers need to be cognizant of during the transition.
APMs are the alternative; although there are limited options to join an APM in 2017, this may change in coming years. Currently, the ACR is exploring a rheumatology-specific APM, which will be designed to give rheumatologists the resources and flexibility needed to deliver appropriate, cost-effective treatment for patients with rheumatoid arthritis. Providers can reach out to the ACR to help determine the best way to structure their care to meet the requirements, because following the APM path exempts a provider from the MIPS pathway.
MACRA Implications to Compliance
Compliance officers may feel like bystanders or observers, but MACRA is a catalyst that pushes the participation in compliance not as a process, but as a culture. This requires everyone to view compliance as an important component in the planning, preparation and implementation of operation strategies for efficiency. Because there are clinical practice improvement elements within MIPS that include expanding access to the practice and coordination of care, which includes phone and digital communications, practices will need to maintain security within their reporting functions to avoid HIPAA violations.| | | Next → | Single Page