Payment & Delivery Models

MACRA matters: Action plan for participation inside last 90 days

Like so many of you, I became a doctor because I am passionate about helping people by practicing medicine. I channeled my energy into my own oncology and hematology practice, and I came to realize that my responsibility to my patients extends far beyond the exam room.   

In recent years, health care delivery and quality-based reimbursement have become important focuses of health reform. The Medicare Access and CHIP Reauthorization Act (MACRA) was developed to ensure both patients and physicians benefit. 

I am dedicated to ensuring all physicians can succeed under MACRA. The Oct. 2 deadline for collecting 90 days of data for the 2017 performance year has come and gone, but physicians can still successfully take part in MACRA’s Quality Payment Program (QPP) this year. While some practices can do more, physicians need only report one measure for one patient in 2017 under the minimum participation option to avoid the negative 4 percent payment adjustment in 2019.

The goal of QPP is to streamline Medicare reimbursement and give physicians more resources and greater flexibility to deliver appropriate care to their patients than they have today. It is also meant to empower physicians to grow their practices by improving the financial viability of physician practices in all specialties.

Physicians have been allowed to pick their pace in 2017 under the Merit-based Incentive Payment System (MIPS), one of two available payment models, by selecting full, partial or minimum participation to avoid a negative payment adjustment in 2019. Yet in a recent AMA survey, nearly one-fifth of physicians said they have not yet started preparing for MIPS.

Here’s how you can still participate using steps from the AMA’s MIPS Action Plan and resources from the Centers for Medicare & Medicaid Services.

Determine whether MIPS applies to you using CMS’ MIPS Participation Status Tool. You may be exempt.

Review available performance categories. Under minimum participation, you may submit data for one Quality measure, one Improvement Activity or some of the elements within the Advancing Care Information category. Most physicians will find Quality to be the most intuitive category, as it builds on the former Physician Quality Reporting System and can be reported directly on the claim you submit to Medicare.  

Use the CMS’ Quality Measure Search Tool to select a Quality measure to report on. Consider measures that are most representative of your practice, such as those that apply to your patients or the procedures you perform most frequently.

Identify your reporting mechanism. MIPS components may be reported through qualified registries, qualified clinical data registries or some electronic health records.

Complete your MIPS performance by Dec. 31, 2017. You must successfully collect information about the metric you’ve chosen before the end of the year.

Submit 2017 MIPS data by Feb. 28, 2018.

I encourage you to explore AMA’s “One Patient, One Measure, No Penalty” step-by-step guide for navigating the 2017 performance year and 2019 payment year.

You can also visit the AMA’s MACRA page to learn more about the organization’s involvement in Medicare payment reform policy and for viewpoints on the various components of MACRA.

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