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May 31, 2017 | 2017 MACRA Requirements Update: Key Facts

It comes as no surprise that the arrival of the Medicare Access and CHIP Reauthorization Act (MACRA) and The Merit-based Incentive Payment System (MIPS) has put many on edge. What was once introduced as a concept has officially been implemented and now requires physicians and practices to submit their attestations for 2017.

Is this a burden for practices and staff? What exactly are the requirements and what do they entail in terms of resources and complexity?

MACRA Reporting Requirements

If you have not been following MACRA changes closely, chances are, you might not have the right information at hand. Data is continuously reviewed, changed and requirements evolve.

However, if you haven’t been following at all and basically avoided it like the plague, here are some key facts about MACRA, MIPS and CQM for 2017:

• MIPS begins in 2017 and replaces and consolidates many of the existing CMS programs like Medicare Meaningful Use and PQRS.
• It has four categories: Quality, Advancing Care Information (ACI), Improvement Activities, and Cost.
• Each category has its own scoring requirements, which when combined together, gives you a MIPS Composite Score.
• Based on your MIPS Composite Score, eligible clinicians can receive a payment adjustment, either positive or negative.
• For 2017, the reporting period for performing the activities in the Quality, Advancing Care Information, and Improvement Activities are 90 consecutive days. The Cost category is not required for 2017.
• You can submit your MIPS Composite Score at the individual clinician as part of your group. Payment adjustments are made at the NPI/TIN level.
• While the scoring details on the MIPS composite score can be complicated, CMS has designed the scoring in 2017. This way eligible clinicians just need to submit something in one of the categories to prevent a negative payment adjustment. Three points guarantee a neutral payment adjustment, and anything above that provides a positive payment adjustment for 2019. Submitting:
  • Just one CQM in Quality category nets you to 3 points. Submitting other CQMs with high scores can net you up to 60 points.
  • The Base Measures in ACI nets you 12.5 points. Submitting all of the ACI measures with high scores can net you up to 25 points.
  • One medium weight Improvement Activity nets you to 7.5 points.
  • Additional Improvement Activities can net you up to 15 points.

2017 presents a great opportunity to see just how many points you can get by continuing to work as you do. It also helps you see the areas you might need to change in order to receive positive adjustments in the years to come.

Healthcare Staff Reaction

Despite the still unclear requirements for most, practices are not looking into hiring additional staff for the transition to value-based care and the implementation of the new payment system under MACRA.

As a 2017 Staff Salary Survey reports, 87.2% of practice managers and administrators don’t foresee hiring staff to help with the MACRA transition.

According to the same survey, the top reasons for not hiring additional staff for MACRA are the following:

Although adhering to MACRA and MIPS requirements can be complex in the beginning, hiring additional staff for some practices can be more costly than they can handle. On the other hand, for others, they may already be equipped with the staff needed to simply train them on the transition, thus not needing more staff members. Finding the right fit for your practice starts with understanding what MACRA is, what it entails, and what you need to adhere to.

AMA offers great resources to learn more about MACRA and where you stand under the new payment reform. CMS also puts forth valuable information.