3 key things medical practices are doing to get ready for MIPS/MACRA

By Polly Friend, RN, Senior Director of Clinical Strategy, CareCloud

In 2017, there were two tracks of MACRA to choose from: MIPS, the merit-based incentive payment system, and APMs, an advanced alternative payments model. Most providers were, by default, placed in the MIPS program, and providers put in a lot of hard work to avoid penalties during the uncertainty of MACRA’s first year. In 2018, there are even more changes as we transition to full implementation by 2019 and beyond.. Some of the new regulations for year 2 include allowing providers multiple submission mechanisms within the ACI quality and improvement categories, an exemption allowance for practices with less than $90,000 in allowed charges for up to 200 patients in Medicare Part B, and the option of participating in MIPS as an individual or a group, including a new virtual group option.

As adjustments are being made to MIPS, action needs to be taken now, so providers can stay ahead of whatever curveballs are thrown. Medical practices are going to need to “build the plane while flying it,” to some degree. The 2018 year 2 rules were finalized on November 2nd, giving practices lead time to position themselves for success. After months of helping practices design and execute MIPS action plans, we’ve distilled the information gathered into the top three things medical practices can do to get ready for the 2018 MIPS/MACRA landscape.

1. Choose which measures to report on wisely

Though there are 270+ MACRA measures available, many are specialty-specific, so not all will apply to your practice. Still, narrowing down which you will choose to report on can be complex. There are a few ways to approach this. First, it’s important to understand the definition of each measure. When choosing which measures to report on, your practice will be expected to report only on those that are applicable or relevant to the services you provide. For an in-depth look at specific measures that your practice will need to report on, The Centers for Medicare and Medicaid Services provides a helpful resource library. Additionally, the Department of Health and Human Services Early Implementation Review: CMS’s Management of the Quality Payment Program offers valuable insights that can help your practice understand specific MACRA measures.

Once you’ve narrowed the measures down to only those that you could be eligible for, you can turn to your billing data to identify the most frequently reported procedures and diagnosis codes and look for measures that include those. Another good way of choosing measures is through patient eligibility. Use the analytics tools in your EHR, PM, and billing systems to look at the data of your patient population and identify which measures would apply to them. It’s important to avoid those that have less than 20 eligible cases because they’ll receive an automatic minimum score, regardless of how good your performance is.

When choosing measures for your practice, it’s important to understand not just which are applicable to you but also which you can do well with. Setting your practice up for success under the new MIPS/MACRA laws requires some upfront legwork but, ultimately, will help you mitigate the risk of a penalty and increase your chance of receiving an incentive.

2. Make sure your clinicians are on board

The shift toward a value-based healthcare system addresses more than just patient satisfaction and practice revenue. There’s also a heavy, albeit indirect, focus on physician burnout. Put simply, when your physicians are overworked and spread too thin, they won’t be able to deliver the best care to their patients. This directly impacts your MIPS score. Before finalizing the measures you’ll report on, it’s important to get your clinicians on board. Better than anyone else, they will understand which measures are appropriate for them and which will allow them to best demonstrate the quality of care they provide. Doctors who have gone through rounds of Meaningful Use policies may feel resentment toward this latest set of changes under MACRA.

The ability and willingness of your staff to adhere to value-based care and strive toward the final measures should be weighted heavily. To encourage engagement and ownership, consider having a brown bag lunch session and soliciting your clinicians’ ideas for making the transition a success. Another way to engage your providers is to have them brainstorm ways to track and show progress on the measures they’ll be reporting on. For example, they may want to see weekly reports or monthly posters on the practice walls. The way your providers want to show progress should be amply supported as another way to encourage participation.

3. Ask your EHR or vendor for help

Once your entire team is on board with the MIPS measures your practice will report on, you can work with your EHR to determine what documentation is needed. Most EHRs will provide you with the support you need so you can submit the minimal requirements to avoid a penalty and prepare a plan for next year so you can get the incentive.

One of the most important things your EHR can provide is a guarantee program of some kind. CareCloud offered a 2017 MIPS Guarantee, which ensured clients received full assurance of avoiding penalties during the uncertainty of MACRA’s first year. With the higher threshold of activity that will be required in 2018 and beyond, guarantees like this aren’t as easy to support. Still, you don’t want to carry a double risk by paying for a technology that can’t support your needs while you’re also trying to navigate a program that has a lot of potential for change. Though you may not be able to get a no-penalty guarantee, your EHR should offer some kind of protection on the technology side.

We don’t know what’s ahead with MIPS/MACRA in the year building up to what should be full implementation, uncertainty still exists, but we can still be ready. Taking action now to prepare for pending changes can help your practice mitigate the risk of a penalty and, ideally, work toward earning an incentive.


This article originally appeared in HISTalk Practice.