Who’s ready for MACRA/MIPS? Why Aprima is, of course!

Who’s ready for MACRA/MIPS? Why Aprima is, of course!
Based on the MIPS composite performance score, providers will receive adjustments based on these percentages.*


In case you missed the news, CMS announced on September 8 that physician practices had some options in terms of complying with the new MACRA cost and quality program. This concession was made in response to Congressional pressure and offers some flexibility for the program, which goes into effect in 2017.

Backup a second – what’s MACRA?

In case you are feeling a bit in the dark about the whole MACRA initiative, you aren’t alone. A recent Deloitte survey of 600 doctors from around the country found that half weren’t even aware of the coming rule.

Here are the basics. The MACRA legislation was passed in April 2015 and CMS released a proposed rule on the law in April. The final rule is expected in November. As things stand today, when the rule goes into effect January 1, 2017, data that is reported on physician performance will be used to determine awards and penalties beginning in 2019.

MACRA includes two tracks – one for physician groups still largely operating in the fee-for-service realm, called the Merit-Based Incentive Payment System (MIPS) and those practices with the bulk of their business in alternative payment models (APM).

The APM track will allow practices to use the cost and quality measures dictated by their alternative payment contracts to satisfy CMS requirements, and enable those practices to earn up to five percent more than their current reimbursement rates.

But the vast majority of practices, even those with some risk-sharing agreements, won’t meet the high bar CMS has set for the APM program. Complicating matters, practices seeking inclusion in the APM track won’t hear whether they’ve been accepted until 2018, after the first year of performance reporting.

Most groups should thus prepare to meet the requirements of the MIPS track. Groups subject to MIPS rules will have the opportunity to earn up to an extra four percent (or lose up to four percent) on its reimbursement rates in 2019 (based on 2017 performance). The carrots and sticks ramp up to a potential nine percent gain or loss by 2022.

So what’s new?

CMS essentially gave physicians a temporary reprieve for reporting. Practices now have four new options for 2017:

a)      Submit any data at all to avoid penalties (but forfeit rewards)

b)      Comply fully, but start later than January 1

c)      Comply fully starting on January 1

d)      Prove most business is in alternative payment models (APMs)

The Benefits at Stake

It may be tempting to take the reprieve as an excuse to put off fully complying with the law. But practices that do delay are leaving money on the table. The plain truth is that MACRA presents a great opportunity for independent physician groups to access significant rewards for quality, efficient care – rewards that have most often flowed to large practices within Accountable Care Organizations or large health systems. What’s more, practices can likely leverage their existing investments in EHRs to reap these benefits.

CMS took into consideration the added burden the new regulations may pose for smaller practices. The agency has set aside $20 million a year to provide technical assistance via Quality Improvement Organizations (QIOs) and Regional Extension Centers (RECs) to practices with 15 or fewer eligible professionals. Priority will be given to practices in rural areas, health professional shortage areas, and medically-underserved areas.

Another cause for relief is that this cost and quality program is not entirely new. MACRA consolidates and replaces a number of value-based reimbursement programs, including the Physician Quality Reporting System (PQRS), Meaningful Use and the Value-Based Payment Modifier. As an Aprima client, you’ve had the necessary collection and reporting tools to participate in all these programs for quite some time (though a few tweaks may be required once CMS releases the final rule.) 

The Nitty Gritty

The beauty of MIPS is that it offers increased clinician flexibility by allowing providers to choose measures and activities appropriate to the type of care they provide. This is an important improvement over the programs MACRA replaces. Here is a breakdown of the reporting requirements for 2017 in the proposed rule:

Quality Score: 50%

This requirement replaces the PQRS and the quality component of the Value-Based Payment Modifier. Clinicians would choose six metrics (down from nine in the PQRS) that best convey practice quality and include a variety of options tailored to different specialties and physician group types. Aprima’s EHR is ready to help providers handle this today.

Advancing Care Information: 25%

This requirement effectively replaces Meaningful Use and allows clinicians to select customized metrics that best reflect their day-to-day use of EHRs, instead of the “all or nothing” approach of MU. There would be an emphasis on interoperability and information exchange, and quarterly reporting would be eliminated. Aprima’s EHR is ready to help providers handle this today.

Clinical Practice Improvement Activities: 15%

Clinicians would be rewarded for activities focused on care coordination, beneficiary engagement and patient safety. Clinicians may select activities that match goals they have set in their practices, from a vast list of 90 options. Here, practices could also receive credit for any participation in APMs or patient-centered medical homes (PCMH). Aprima’s EHR is ready to help providers handle this today.

Costs: 10%

This replaces the cost component of the Value-Based Payment Modifier, also called Resource Use. Clinicians would have no reporting requirement for this portion of the MIPS score, which would be based on Medicare claims. However, practices will want to closely monitor cost trends to best compete on this measure.

Aprima is ready

If you are an Aprima customer, you are aware of our strong track record of compliance with government initiatives. We are here to provide all the guidance you need to help you succeed.  As such, you should not fear MACRA/MIPS.

If you attended the 2016 Aprima User Conference, you had the opportunity to hear keynote speaker and healthcare law expert Sarah Freyman Fontenot, BSN, JD, CSP provide an overview of MACRA and MIPS and are aware that Aprima is MIPS-ready. Based on the proposed rules, the Aprima platform will meet the functionality requirements for Medicare’s proposed rules for the MIPS upon completion of Meaningful Use Stage 3 Certification for the Aprima EHR/PM. The system already has the functionality required to address the component parts of the new law, including Meaningful Use and PQRS, plus the requirements of the Value-based Payment Modifier program.

We are here, should your practice need help accumulating all of the metrics that will comprise your customized quality score, and assist you with seamless recording of “advancing care” activities. We can also verify that you are capturing all your clinical practice improvement activities and that users know how to monitor and control utilization and costs.

Regardless of what the final rule entails, Aprima is committed to aligning solutions with the functionality that practices need to meet Federal requirements and optimize incentives. While these new regulations may demand some changes in workflow and operations, users can be assured that Aprima is here to help practices through the January 1, 2017 transition and beyond.  

Neil Simon, Aprima COO

With the final rule on MACRA anticipated in November, Aprima COO Neil Simon explains what you need to know right now. Read the article here

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