by David Chou

Winning strategies for MACRA and MIPS

Oct 24, 2016
Electronic Health RecordsHealthcare IndustryIT Leadership

We have received the almost 2,400 pages of the final rule on MACRA. It's complicated, and now is the time to prepare.

healthcare cost of medication
Credit: Thinkstock

Physicians are understandably concerned about how the new Medicare Access and CHIP Reauthorization Act (MACRA) will impact their practices — not only because physicians will be publicly ranked against one another but also because they could face substantial reimbursement cuts. With reputation, finances and your practice on the line, it will be critical to establish a winning strategy.

But there is a silver lining. The MACRA’s Merit-Based Incentive Payment System (MIPS), which is anticipated to initially apply to more than 90% of eligible clinicians, offers a significant opportunity to come out ahead in the shift toward value-based care. Preparing for the requirements and ensuring patient satisfaction enables you to position your practice to be among the winners — year after year.

Under the MIPS, eligible clinicians will receive positive, negative or neutral adjustments from 2019 to 2022 and beyond based on their relative performance versus peers. Top performers have the potential for bonuses as high as 14% in 2019 plus an additional 8% (subject to budget neutrality), which increase annually to as much as 19% by 2022, topped off with an additional 18% (subject to budget neutrality). Those that underperform compared to their peers will be financially penalized, with the bottom 25% of eligible clinicians seeing their revenue cut by 9% by 2022. The look-back period begins in January of 2017… how prepared are you?

Here are three winning strategies to remain competitive under MACRA:

  • Establish a comprehensive chronic care management (CCM) program: For example, under Current Procedural Terminology (CPT) code 99490, practices are reimbursed on average $42 per patient, per month, for non-face-to-face care management services, such as monitoring patient progress, medication adherence and sending appointment reminders will help improve outcomes and can now be monetized. CCM provides poly-chronic patients with the level of care necessary to keep them well and minimize preventable utilization, which is critical under MACRA. CCM also subsidizes the foundational technology and operational capabilities necessary to succeed under MACRA, such as interoperability across all care settings, asynchronous patient communication, and better care management methodologies. Most medical practices conduct non-face-to-face follow up with their high-risk patients anyway; CCM offers a financial incentive for providing a more structured, consistent and proactive approach to patient care between office visits to improve outcomes.
  • Expand care coordination: As you no doubt know, the MIPS will measure physicians on a weighted performance score comprised of four categories — quality, advanced care information, clinical practice improvement, and resource use/cost. These categories provide a concrete scale to measure your current activity, demonstrate areas that need to be addressed, and determine your performance compared to your peers. Care coordination and electronic document exchange, which go hand in hand, are components of all four categories. Additionally, cost, which is arguably the most difficult category, starting with 0% in first year gradually increases to 30% of the composite MIPS score for the 2019 measurement period. The ability to maintain visibility into a patient’s status and coordinate their care as they are referred and/or transition across the continuum of care will no doubt be a key area of differentiation for strong performers. As outlined in the MACRA final rule, the ability to exchange and use information across multiple systems and healthcare organizations is integral to a healthcare provider’s demonstration of the MACRA. Better care coordination will require investments in people to help facilitate with patients and technology such as referral management.
  • Improve patient engagement: Patient-centered care is one of the primary goals of CMS, so it is no surprise that there are elements of patient engagement in three of the four categories of the MIPS score — quality, advancing care information, and clinical practice improvement. Current “push” strategies of making information available via patient portals have not been terribly effective at improving patient engagement. To effectively engage patients, clinicians will need to provide real value to patients, proactively engaging them in a relevant, meaningful way at every stage of their healthcare journey. Providers will also need to communicate with patients the way human beings communicate with the rest of the world — via mobile device.

Chronic Care Management truly sets the healthcare organization on a path for successful management of Medicare populations, improved outcomes and MIPS performance. Providers have a real opportunity to thrive under MIPS long term with the help of established incentive programs such as CCM, better care coordination and improved patient engagement — all the while improving patients’ well-being. It’s a potential win-win-win for proactive practices, their patients and the healthcare system overall.

For healthcare technology executives, the main points of MACRA that must be supported by IT include, but are not limited to, the following:

  • Electronic prescriptions.
  • Protecting patient health information, including the use of security risk analysis.
  • Provide patients with electronic access and educate patients about program usage.
  • Coordinate care through patient engagement, including secure messaging, view-download-transmit of summary care information, and patient-generated health data.
  • Exchange of health information, such as patient care records, and reconciliation of clinical information.
  • Reporting of immunizations to public health organizations and clinical data registries.

I recommend that healthcare CIOs partner with their physician leadership in sponsoring the required training for personnel who will be involved with the EHR workflow process. This regulation has a huge impact on physicians and we must help them prepare for the change now.

Note: I had the privilege of having Lisa R. Esch (@lisaesch), chief population innovation officer at CSC, co-author this blog post in order to provide a population health leader’s perspective on this issue.