If Medicare payment reform feels too "big" to your practice right now, start slowly by covering the basics.
With the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) steaming full speed ahead toward medical practices, it’s time to be ready for payment changes.
When it comes to the Merit-based Incentive Payment System (MIPS), healthcare management consultant Mary Jean Sage of The Sage Associates in Pismo Beach, California, urges physicians to be proactive instead of reactive to reap the program’s benefits.
1. Know that MIPS is your friend.
Yes, this is all new, but physicians have done new before, she says. Also remember that some existing Medicare programs are simply renamed but that MACRA is here to stay. Decide now if the practice wants to survive or thrive, and be aware of the financial implications of that decision, Sage says.
2. Maximize available MACRA educational resources.
Because physicians want to thrive, get educated about MIPS as part of MACRA. They can't make the right decisions if they don't know what to do. Practices can hire someone to help, but why not start with the comprehensive Centers for Medicare & Medicaid Services (CMS) website. Professional organizations have additional help, including the American Medical Association (AMA).
Also remember that if physicians have participated in any of these three programs, the transition will be much easier.
· Physician Quality Reporting Program (PQRS): 2007 – 2016 -> becomes the Quality category in MIPS
· Value-based Payment Modifier: 2015 – 2017 -> becomes the Cost category
· EHR Incentive Program / Meaningful Use: 2011 – 2018 -> becomes the Advancing Care Information category
3. Pick your path of participation.
If physicians currently care for Medicare patients, they may have to choose MIPS instead of participating via an advanced Alternative Payment Models (AAPM). "This is actually the first important decision you need to make," Sage says. For the first year under this new curriculum, most peers are not taking the road less traveled-they are participating in MIPS. Once physicians have made this big decision, they will pick program components and decide what they are going to report on.
4. Stay in touch with your practice's electronic health record (EHR) or practice management vendor.
What physicians can do next to prep for MIPS may be determined by what system they operate. Like many others, practices may need to upgrade before going forward. And for that, physicians may have to get in line, so get scheduled now for that update. The new component in MIPS-clinical improvement activities-means that the system needs to be able to report that component.
5. Pick your pace continues – in theory – in 2018.
"With your equipment in order, it's time to pick your MIPS measures," Sage says. "You'll have to do this no matter what pace you picked."
This year, if physicians don't participate in the Quality Payment Program, they will receive a negative 4% payment adjustment that gets applied to 2019 payment.
CMS really is making things a bit easier for smaller practices. This year, physicians can choose to either a "test" pace (submitting one piece of data) or to do partial or full data reporting. After physicians report, they will assess how they did during the year to inform decisions about next year, where physicians will have to submit a little more data to avoid a payment penalty.
Remember, this program is ongoing, so be prepared to continue and to succeed. The results will be posted on the Physician Compare website for everyone to see.