MACRA Has Arrived—& What You Do Now Counts

Kwas Huston

The Cost Factor
Another important calculation is how much it will cost to collect and report the data required under MIPS.

“CMS has said it will mitigate smaller practices, likely those that have fewer than 100 patients and bill less than $90,000, and some rural practices,” Dr. Herzig says. “But every rheumatologist is being measured. Just who will be included in the program has yet to be finally determined.”

Rheumatologists who participate in RISE, the Rheumatology Informatics System for Effectiveness Registry, created by the ACR, automatically meet some of the MIPS measurement criteria.

“RISE sits on top of your electronic medical record and extracts needed data for you,” Dr. Herzig says. “We are encouraging all rheumatologists to be part of RISE, even those who are part of larger healthcare systems.”

The APM Path
MIPS is not the only evaluation system available under MACRA. Alternative Payment Models (APMs) provide the other path, but few APMs have been approved by the CMS to date, and there are no APMs in rheumatology. For now, most rheumatologists will continue to be evaluated under MIPS. That will change. An ACR working group chaired by Drs. Herzig and Huston is developing a rheumatology-specific APM. The APM will focus on the most common rheumatologic disease, rheumatoid arthritis, but once approved, the model can be adapted to other diseases.

“We have a draft APM, but work remains to be done,” Dr. Huston says. “We are working hard to develop a rheumatology APM for the future, but we all need a plan for what we will be doing this year and how we will deal with MIPS over the next two or three years. MIPS is where we are now, but MIPS, in its current form, is not a long-term, sustainable plan for rheumatologists. The APM is on the way.”

Don’t Miss It!
Don’t miss this session, Holy MACRA: How to Survive and Thrive in the New Era of MACRA, MIPS and APMs, Sunday, Nov. 5, from 8:30–10:00 a.m. in Room 6D.