What the Shift in Quality Reporting Under MACRA Could Mean for Your Practice

As healthcare continues its shift from volume- to value-based care, the quality of care that you and your practice provide has never been more important. This focus on quality—and the quality metrics that support it—will not only change the way you care for your patients. It will also change the way you are compensated for that care.

Why pay more attention to quality now?

While value-based payment adjustments under the Medicare Access and CHIP Reauthorization Act (MACRA) don’t begin until 2019, the Centers for Medicare & Medicaid Services (CMS) will use performance data from 2017 to determine payment adjustments in 2019.1 That’s why it’s important to determine what actions you can take now to improve quality in your practice.

 

A brief review: MACRA’s payment paths—MIPS and APM

MACRA requires that clinicians who treat Medicare patients choose between two payment paths as part of the Quality Payment Program (QPP):

  1. Merit-Based Incentive Payment System (MIPS)
  2. Alternative payment model (APM), e.g., an accountable care organization (ACO)

Learn more about the difference between MIPS and APM. In 2017, most providers will participate through MIPS, with a few exceptions.

 

MIPS gives the most weight to quality

Your MIPS score is based on performance in 4 weighted categories: quality of care, advancing care information, clinical practice improvement activities, and resource use.2

Quality of care currently counts for more than half of your MIPS score. Based on performance in 2017, clinicians will see a positive, neutral, or negative adjustment of up to 4% to their Medicare payments in 2019. This adjustment percentage grows to a potential of 9% in 2022 and beyond.1

 

What this means for your practice

Practices must monitor their progress throughout the year, regularly running reports from their EHRs to catch any discrepancies, so that inquiries and adjustments can be made in a timely manner.

Let’s put this into practice. Say a 79-year-old male who’s eligible for Medicare visits your office for his annual wellness check-up. What information would help you improve his quality of care while maximizing payment under MIPS?

For starters, you need to determine which quality programs he’s eligible for, and what his current compliance status is for applicable quality measures. It could also help to know which tests have already been ordered for the patient by any of his other physicians, to prevent duplicate orders and added costs.

Having this quality-related information at the point of care would enable you to provide any necessary referrals—guiding quality of care activities to ensure that the patient is up to compliance for all relevant measures.

 

Data Diagnostics® can help you improve quality

With potentially hundreds of measures for you to track, measuring quality can be challenging and time-consuming. Under MIPS, you must choose 6 measures to report to CMS that best reflect your practice, including one outcome measure.2

Data Diagnostics® from our QuanumTM technology portfolio can help. Offering quality-related reports, it provides you with a comprehensive picture of your patients’ current or predicted clinical and quality gap status for specific quality measurements, as well as actions needed to improve quality. In the example above, for the 79-year-old male patient, you would be able to order the Comprehensive Clinical Quality Status Profile within your existing workflow, for real-time insight to help guide you—and your patient—toward quality compliance.

As a physician dedicated to patient care, you understand better than anyone that improving quality is essential to a healthier practice—and better health outcomes for your patients.


1. Centers for Medicare & Medicaid Services. The quality payment program overview fact sheet. Available at https://qpp.cms.gov/docs/Quality_Payment_Program_Overview_Fact_Sheet.pdf. Accessed January 24, 2017.
2. Centers for Medicare & Medicaid Services. The Merit-based incentive payment system: MIPS scoring methodology overview. Available at https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-Scoring-Methodology-slide-deck.pdf. Accessed January 23, 2017.