Payment & Delivery Models

Future-proofing your Medicare performance improvement activities

David O. Barbe, MD, MHA , Former President

It’s often said that the only constant is change, and nowhere is this more evident than in medicine. Medical research, technology and health care policy are constantly evolving, and so too must we, as physicians and practice managers. This is especially true in the current environment, as we consider how our limited time and resources are best channeled into meeting the Merit-based Incentive Payment System (MIPS) requirements under the Medicare Access and CHIP Reauthorization Act (MACRA).

There are a number of improvement activities available to physicians under MIPS, but not each is a fit for every practice. As physicians, we need to consider the strategies that will best support the growth and sustainability of our practices and the needs of our patients. One of the goals of MACRA is to methodically shift providers further along the value-based care spectrum, and many of us are beginning to think beyond MIPS to Alternative Payment Models (APMs), the other payment pathway available to physicians under MACRA’s Quality Payment Program (QPP).

Participation in APMs is being incentivized as they offer an opportunity to improve care and reduce spending for payers and patients. MACRA provides a 5 percent annual lump-sum payment to physicians who participate in certain APMs at qualifying threshold levels, and it exempts them from MIPS requirements. Those who participate at levels below the requisite thresholds, or in other APMs, will be scored using a special APM standard in MIPS. A growing number of medical specialty societies are working in partnership with their members to develop APM proposals that Medicare and other payers can implement under MACRA.

Related Coverage

EHRs in the era of MACRA

Taking purposeful steps to align our current practice-improvement efforts under MIPS with the eventual demands of APMs is a great way to future-proof our investments. Luckily, there are numerous resources available to facilitate understanding MACRA, identifying areas for practice improvement and developing long-term strategies for increased efficiency, better patient care and cost savings.  

The AMA’s MACRA page offers a comprehensive overview of QPP and a 10-minute assessment to help physicians determine its potential financial impacts on their practices. Visitors can drill down into the components of MIPS and create a dynamic action plan to measure performance against important dates and recommended steps.

On the Centers for Medicare & Medicaid Services (CMS) website, physicians can access the list of improvement activities under MIPS and can gauge the importance of individual activities to their practices. Some improvements, such as investment in certified electronic health records (EHRs) and increased access to clinicians, are widely applicable, while others are better suited to certain clinical specialties. Forward-thinking physicians should consider easily integrated activities that improve the overall quality of the care they provide. Examples include:

  • Improved chronic care and preventative care management.
  • Inclusion of patients, families and caregivers in care plans.
  • Investment in tools and processes that promote patient engagement and facilitate the timely exchange of information.

Additionally, the AMA’s STEPS Forward™ series is an improvement strategy in and of itself, focused on efficiency and improving patient care. Physicians interested in implementing formal quality improvement methods, practice changes or other practice improvement processes under MIPS will find modules on workflow and process, leading change and technology and finance.

While change is a constant, it doesn’t have to happen all at once. This is the first year physicians need to report on quality measures under the QPP. Those of us who chose the MIPS payment pathway but missed the deadline for reporting a partial year need only collect data on one measure on one patient before the end of the year to avoid a 4 percent payment reduction in 2019 under MIPS. Reference the AMA MACRA page for regular updates on MACRA in participation in 2017, 2018 and beyond.

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