Encouraging physicians to switch to electronic health records (EHR) has been a long term effort from CMS ever since the January 2009 passage of the HITECH act. Over three-quarters of physicians and nearly all hospitals are using an EHR but the incentivizing structure has been hard to wade through, at best. Now healthcare professionals and physicians alike must focus their efforts on understanding the end of the SGR formula and the beginning of The Merit Based Incentive Payment System and Alternative Payment Models.
In 2012, a policy known as Meaningful Use (MU) began as a way to incentivize physicians to switch to an EHR. It has had been largely successful and is in the last stage, Stage 3, of implementation.
In 2015, the bipartisan reform legislation called Medicare Access and CHIP Reauthorization Act (MACRA) was passed. The goal of MACRA is to help change Medicare payments from quantity to quality based. It is also simplifying the reporting process for healthcare providers by merging Meaningful Use and PQRS together.
At close to 1,000 pages of legislation, MACRA is the biggest face lift of the medicare system in decades, which promises to change the way physicians are paid. Instead of the current fee-per-service model, it will be practice-driven, focused on connecting with patients, and rewards high quality care.
The 962 pages detail how CMS will manage the two programs stemming from MACRA: The Merit-Based Incentive Payments Systems (MIPS) and Alternative Payment Models (APMs).
Changes begin to roll out in 2017, so physicians need to begin now to understand the new structure.
As Kate Goodrich, MD, director of the CMS Center for Clinical Standards and Quality, noted during a May 17th joint meeting of the Health IT Policy and Standards committees, the Advancing Care Information (ACI) under MIPS is the same as Meaningful Use.
The CMS proposal shows a new ACI performance score under MIPS, which takes away the old "all-or-nothing" scoring and makes up 25% of the MIPS score. The new ACI performance score is designed to make the requirements more simple, support patient care, and be flexible to meet the needs of practices. The end goal is that Advancing Care Information will create a system that is more simple and connected, with less taxing technology.
The proposed changes will affect physician practices by greatly simplifying the scoring process for them. Currently, there are 18 measures to report on, whereas with the new system, only 11 would be required.
As well, as mentioned above, there is no longer an "all-or-nothing" approach. Physicians are able to select criteria to focus on for their practice and choose which measures best suit their practice.
Perhaps the most alarming thing about the MIPS program is how little awareness there is about it. "A lot of people may not be aware that the MACRA legislation passed last year," says Jennifer Gasperini, director of health policy for the North Carolina Medical Society. "The majority of our members are just now waking up to the fact that the world around them is changing. We would recommend they do some work to get ready now. The longer you wait, the harder it is going to be. Get familiar with existing quality programs and understand the timelines for this new structure that has been set up through MACRA."
Advanced Care Information (ACI) is only one section of four within the MIPS scoring system. The other three sections include clinical quality, making up 50% of the the whole score in the first year; resource usage, making up 10% of the score in the first year; and clinical practice improvement activity, making up 15% of the score in the first year.
Adding in the score for advanced care information, for 25% of the total score in the first year, physicians will receive a total score in 2017 that will be used for payments in 2019.
With a "carrot and stick" approach, the physicians who perform best will also be qualified for bonus payments of up to 10% from 2019 to 2024. Physicians scoring below a certain threshold will see opposite changes to their payments. Penalties will range from a maximum 4% in 2019 to 9% in 2022 and beyond.
At the end of the day, the progress to medicare and medicaid payments stem from a goal of constant improvement over time. Although the changes in MACRA aren't perfect, they are headed in the right direction.
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