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5 Things to Know About MACRA’s Quality Payment Program

Created Jan 02 2018, 09:06 AM by Lippincott Solutions
  • Centers for Medicare & Medicaid Services
  • MIPS
  • Health care quality
  • CMS

Public comments on the final rule set to guide the second year of the Quality Payment Program under the Medicare Access and CHIP Reauthorization Act (MACRA) are open through January 1.

“While much of the rule isn’t health care IT specific, many of the top challenges will place demands on technology in order to cope with the changes,” experts from the Advisory Board wrote in an overview of the 2018 rule published in Health Data Management.

Here are a few aspects of the rule Health Data Management contributors Tony Panjamapirom and Rob Lazerow said could affect health care organizational planning and information technology efforts going forward.

  1. THERE’S MORE FLEXIBILITY

Although the structure of the Quality Payment Program is mostly unchanged, more flexibility exists for providers. There are more ways to succeed under MACRA, which is likely welcome news for smaller organizations, the experts wrote.

  1. MORE CLINICIANS ARE EXEMPT FROM THE MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS)  

The proposed rule expands MIPS exemption to providers and groups with fewer than 200 Medicare Part B beneficiaries or less than $90,000 in Medicare Part B charges. This change will hike the number of clinicians excluded from MIPS and the Quality Payment Program by 123,000, the contributors explained.

  1. BONUSES ARE AVAILABLE

Smaller practices can gain an extra 5 points on their final MIPS score by submitting performance data in at least 1 category, according to the overview.  Another 5 bonus points are up for grabs for practices with populations considered particularly complex.

Although clinicians aren’t required to upgrade to 2015 edition Certified Electronic Health Record Technology, those that use it to report the Advancing Care Information transition measures could reap a 10% bonus score.

  1. THE FOCUS ON QUALITY & COST INTENSIFIES

The reporting period for the quality performance category will increase to an entire calendar year next year. What’s more, requirements for data completeness will grow to 60% for electronic heath records, registry, and claims-based submission methods, the experts cautioned. Additionally, the Centers for Medicare & Medicaid Services will begin assessing cost measures, which will comprise 10% of the MIPS final score. In 2019, they will be 30% of the MIPS final score.

“Providers must prioritize their quality performance improvement and cost control efforts in 2018,” Panjamapirom and Lazerow wrote.

  1. PENALTY AVOIDANCE THRESHHOLDS ARE RAISED

To steer clear of a payment penalty in MIPS in 2019, providers must have earned 3 points across the MIPS categories in 2017. By 2020, those hoping to avoid a penalty must have earned 15 points in the MIPS categories in 2018.

“This is still a fairly low bar to clear,” the experts reflected, “and may dilute bonuses in 2020 for high performers.”

 

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