Thinking Strategically About MACRA and MIPS: Will it Be Sink or Swim in 2019? (Part 1 of 2) | Healthcare Informatics Magazine | Health IT | Information Technology Skip to content Skip to navigation

Thinking Strategically About MACRA and MIPS: Will it Be Sink or Swim in 2019? (Part 1 of 2)

May 10, 2017
by Heather Landi
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Numerous industry surveys have highlighted that U.S. physicians, by and large, remain unprepared for managing and executing Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) initiatives. In fact, an exclusive survey conducted by Healthcare Informatics and SERMO found that just one in five practices (20 percent) with 15 physicians or fewer and approximately one in four practices (28 percent) with 16 to 50 physicians report that they are “ready to go” to meet the core requirements under MACRA.

For that survey, Healthcare Informatics surveyed 2,045 U.S. physicians in SERMO across various specialties—revealing that most practices still need MACRA help, with many still stuck in fee-for-service environments. The goal of the joint research was to gauge providers’ readiness for MACRA, a newly-implemented law that will fundamentally change how eligible Medicare physicians will be reimbursed.

Tom Lee, Ph.D., founder and CEO of Chicago-based consulting and software firm SA Ignite, says he is not surprised by survey results indicating that physicians continue to be unprepared to meet the core requirements under MACRA. “Given the level of complexity of the program, and how quickly things have come, I’m not surprised, and I’m sure there are also folks who were trying to follow the repeal and replace activity, which was another distraction,” he says. “Those organizations that don’t have enough dedicated effort to towards understanding the regulations and how to operationalize them, and that will tend to skew toward smaller organizations, those are the types of organizations that the lack of awareness and preparedness will likely have the greatest implications.”

Tom Lee, Ph.D.

Joncé Smith, vice president of revenue cycle management at Stoltenberg Consulting, a Pittsburgh-based healthcare information technology consulting firm, also is not surprised by news about physicians’ lack of preparedness for MACRA. “I think a lot of people felt that a program of this magnitude, size and complexity would ultimately be delayed, but it was not, so I think that has caught people pretty unprepared. And, this program is replacing three of the previous physician reimbursement incentive programs, yet it’s so unlike the pieces and parts of those programs, so I think there’s a very large education curve that’s going to have to take place.”

MACRA, which was passed with bipartisan support in Congress, launched its first reporting period in January 2017 in which eligible Medicare clinicians will be reporting to a Quality Payment Program (QPP) that determines a physician’s reimbursement based on the high quality, efficient care they provide that’s supported by technology. MACRA includes two payment tracks that eligible Medicare clinicians can take part in that will determine their payment adjustments in future years. Early on in the program, most of these clinicians are expected to participate in the less risky Merit-Based Incentive Payment System (MIPS) track as opposed to the Advanced Alternative Payment Models (APMs) track.

Mark Miller, M.D., an independent family medicine physician who practices in Fayetteville, Arkansas, says that independent practices are struggling with the complexity and aggressive timing of the rule. “There’s a lot of uncertainty. I have talked to my colleagues and they have heard of it, and for those who are employed physicians, they are trusting that their office manager is going to take care of reporting, but as far as the independent doctors, they are going have to do it themselves,” he says, adding that at a recent American Medical Directors Association conference, when the 150 physicians in the room were asked if they were already actively engaged in MACRA, only two raised their hands. “I think physicians as a whole know very little about it and will be blind sighted by it.”

Preparation Strategies

The Quality Payment Program combines the existing Medicare Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs into MIPS, starting with the 2017 performance year. MIPS payment adjustments are applied to Medicare Part B payments two years after the performance year, with 2019 being the payment adjustment year for the 2017 performance year.

MIPS defines four categories of eligible clinician performance, contributing to an annual MIPS final score of up to 100 points. The four categories are Quality; Advancing Care Information (ACI, renamed from Meaningful Use); Clinical Practice Improvement Activities (CPIA) and Resource Use (which will be weighted for 2018 and beyond).

Miller recommends that physicians first educate themselves on MACRA and MIPS requirements using the QPP portal developed by CMS— On that site, CMS offers an online lookup tool that enables clinicians to determine whether they have to participate in MIPS this year.

Mark Miller, M.D.


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