In the high-stakes transition to Medicare's new value-based payment system, physician organizations face a looming deadline to attain full compliance with MACRA's data reporting requirements, which will drive payment bonuses and penalties for clinicians.
With implementation of Medicare's Quality Payment Program (QPP) shifting to high gear in January, most physician practices are either fine-tuning capabilities for the new value-based payment system or facing multiple pain points.
In 2015, Congress established the QPP through the Medicare Access & CHIP Reauthorization Act (MACRA). There are two payment tracks under QPP:
- Starting in 2019, most clinicians receiving reimbursement through QPP will be paid through the Merit-based Incentive Payment System (MIPS), which features data reporting in four performance categories that drive payment bonus and penalty mechanisms
- Clinicians participating in MACRA-approved alternative payment models (APMs) such as the Medicare Shared Savings Program can earn 5% payment bonuses.
"Pick-your-pace" reporting for QPP started this year, with associated payment adjustments set to begin in 2019. A more mandatory approach to QPP data reporting—with bigger financial consequences for clinician compensation—begins next year.
The American Osteopathic Association (AOA) is urging its members, which features more than 100,000 doctors, to view QPP as an opportunity to improve physician practices.
"We are focused on raising MACRA awareness among our physicians, and helping physicians to educate themselves about practice improvement. A lot of practice improvement strategies are not just about excelling in MIPS—they are ways to improve efficiency, have better care for patients, and have happier employees," says Laura Wooster, senior vice president of public policy at AOA.
There are several keys to MIPS success. "A good EHR is a good start. Any kind of system that helps a practice with population-health management is a great step for maximizing performance," she says.
"For example, it helps to have the capability to track all of your diabetic patients, and to make sure you have brought them all in over the past year to check their hemoglobin-A1C or conduct a foot exam. It helps to look at your patients as different groups and make sure they are getting the best care to manage their health."
Christopher Cheney is the senior clinical care editor at HealthLeaders.