MACRA Differentiates Top Tier Performers - Will You Run with the BIG Dogs?


November 25, 2016

MACRA Components - Quality & Cost - Will Differentiate the Top From the Bottom Tier Performers

The way you are paid for taking care of Medicare patients will change on Jan 1, 2017. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was released on Oct 14th in its final rule - nearly 2400 pages of detail. By replacing & rolling several existing programs into MACRA, CMS is working to simplify the administrative burden for Medicare Part B payments and quality reporting. The impact will be a transition from fee-for-service to value and quality business model in the physician practice.

MACRA creates two payment tracks: Advanced Alternative Payment Models (APM’s) and the Merit-Based Incentive Payment System (MIPS). It is estimated that 600k+ providers will be impacted by MACRA. Advanced Alternative Payment Models will be discussed in a future post, as aAPMs are scored with different criteria.

Under MIPS, eligible clinicians will be scored and ranked against each other nationally, and these rankings will determine payment bonuses and penalties. Scores are based on quality, cost, advancing care information, and clinical practice improvement as follows for 2017:  

  • Quality is 60%
  • Cost is 0% (increases in 2018 )
  • Advancing Clinical Information is 25%
  • Clinical Practice Improvement is 15%

Eligible clinicians subject to MIPS should start preparing now in order to avoid penalties and leverage time for process improvements. The best strategy is to focus on the two components of the MIPS score that will most differentiate high and low performers as the program evolves: quality & cost.

Quality is more heavily weighted in the first few years and is expected to be a differentiator among the middle and bottom tier performers in years 2019 - 2020. Those that have experience (and success) improving quality will achieve top rankings. This is easier said than done. Quality metrics are impacted by the entire TEAM. Focus on strengthening the weakest links.

Cost is much more difficult to control, and it is expected to be the most highly differentiating category. According to CMS insider, the cost score will be based on claims for up to 10 episode measures, each worth up to 10pts. CMS is taking comment on method - let your voice be heard. The key to success is the ability to control cost.

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