How to succeed under MIPS

Since 2015, when Congress passed significant Medicare payment reform legislation, primary care physicians have treated the measure as something to deal with sometime in the future.

That future arrived January 1. 

The beginning of 2017 marked the implementation of the Medicare Access and CHIP Reauthorization Act (MACRA), which puts real weight behind the federal insurance program’s push to increase the quality and accountability of care.

 

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Though they may not all be aware of it, many practices are now operating under MACRA rules. For an estimated 600,000 practices, that means their Medicare Part B payments are now determined by a new value-based program called MIPS, short for Merit-based Incentive Payment System.

For many primary care physicians, success under the new program will require significant changes in how they deliver care and the ways they track and report the outcomes. MIPS includes new initiatives with new benchmarks, different reporting measures and escalating financial incentives and penalties.  

MACRA is designed to strengthen primary care and position it at the controls of a coordinated network of care providers. And if it works as intended, PCPs will see earnings increase along with responsibilities. But to achieve that, doctors have to learn and then integrate the new program into their practices.  

“You can go outside for advice, but you can’t get someone else to do it. It needs to be central to your practice,” says consultant Jeanne Chamberlin, MA, FACMPE, of MSOC Health in Chapel Hill, North Carolina.

 

Taking stock 

Because the Centers for Medicare & Medicaid Services (CMS) regards 2017 as a transition year for MACRA, practices can choose their pace of participation. CMS hopes MIPS-eligible practices will participate as fully as possible so as to be ready for future years.

Before making that decision, however, practices have to know what’s required, where they stand and how they can improve-knowledge many lack, according to David Zetter, CHBC, CHCC, principal of Zetter Healthcare, a practice management consulting firm in Mechanicsburg, Pennsylvania.

 

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For many practices, success under MIPS, at least initially, will depend on the extent of their previous participation in value-based programs and reporting. MIPS will be easier for those with experience collecting and reporting data for programs such as the Physician Quality Reporting System (PQRS) and Meaningful Use (MU). Those who have yet to participate in value-based programs face a steeper implementation curve.

Practices must decide if they’re up to the task of implementing MIPS, says James M. Daniel, JD, MBA, a healthcare attorney and consultant in Richmond, Virginia. He advises his clients to study the MIPS reporting and performance requirements and compare them to what the practice already is tracking for MU or PQRS. That can help practices decide the extent to which they should participate in MIPS for 2017. 

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