MIPS & MACRA - Secrets to Beating the Curve
The second Tuesday of each month, practice managers and healthcare industry service providers gather for the monthly Nashville Medical Group Management Association (NMGMA) meeting.
During the August luncheon, Julie-Karel Elkin, member in the Nashville office of law firm Spicer Rudstrom PLLC, shared "secrets" to successfully prepare for the new Medicare Access & Chip Reauthorization Act (MACRA) performance standards to 'beat the curve.'
MACRA and the Merit-based Incentive Payment System (MIPS) track are being used to help practices move to a value-based incentive pay system. As with any major change, Elkin said it was critical to get psychologically and physically prepared, recognizing the new system is going to take more time and money and cause initial frustrations ... but there isn't really a choice.
"Your practices are going to be measured against the performance standards of MIPS," said Elkin. Because MACRA is revenue neutral, there will be winners and losers when it comes to achieving bonuses or being assessed penalties. "Money is going to come from one practice and go to another practice," she said.
Elkin added, "The goal ... just like in college ... is we want to beat the curve. We want to make sure we're above that line so we're not the practice where the money is coming from."
The first step, she said, is to look up your provider number by going to https://qpp.cms.gov/participation-lookup. Full participation began in 2017 to impact revenue in 2019, but providers have a number of "pick your pace" options in this first reporting year. Those who didn't opt to participate for the full year also have the opportunity to report for 90 days. To do that, however, Oct. 2 is the absolute latest date to start. This first year also offers the opportunity to avoid a penalty by reporting on one measure before the end of 2017.
There are six submission methods that are MIPS compliant, but not every reporting method supports all measures. Two of those reporting methods - CMS web interface and CAHPS for MIPS survey - required a pre-registration that has already passed.
Elkin said it is important to make sure information is reported accurately via the right method. Like a GPA, she said, MIPS scores are reported in a cumulative manner - the higher an initial score is, the better for a practice in the future.
MIPS is judged based upon the Composite Performance Score (CPS), which is measured in four improvement categories. The total score in this first year is broken down as follows: 60 percent on quality (replaces PQRS), 25 percent for advancing care info (replaces EHR and Meaningful Use), 15 percent for clinical practice improvement activities (new), and 0 percent on cost (not used in 2017 but will be a factor later).
For full credit in 2017, healthcare professionals must report up to six quality measures from a list of 271 and one outcome measure for a minimum of 90 days in order to earn up to 60 points. Next is the advancing care information category that allows up to 155 points to be earned, although only 100 points can actually be used. There are two tracks -the objectives and measures track or a transitional track.
Improvement activities, which nets a maximum of 40 points, requires reporting on activities that improve clinical practice. There are 92 activities under nine subcategories. Providers can submit data on two high-weighted activities, 1 high-weighted and two medium-weighted activities, or up to four medium-weighted activities. While the final factor of cost doesn't count now, Elkin said it's coming so providers certainly need to keep it in mind going forward.
Much like weighted grading categories in a college class, the CPS is achieved by figuring a point total in each category and then adding the category totals together. For example, if a provider earned 50 out of 100 points for the advancing care information category, which is weighted at 25 percent, they would earn 12.5 points in this category (50/100 = .5 x 25 = 12.5 points).
An ideal MIPS score should be above the baseline to avoid penalty. "You want to push your score as high up as you can so you can stay at the top of that curve," explained Elkin.
She suggested practices and professionals alike should not submit the minimum because it will have a negative effect on the bottom line in the future and will ultimately end up costing money down the line. "Don't slack your freshman year and then work on boosting your GPA for the rest of your college career," she noted.
"If I convince anyone of anything ... it's please don't do nothing," Elkin concluded.
Beginning with the Sept. 12 luncheon, NMGMA will have a new meeting location at West End United Methodist Church.
