What is MACRA? It’s the new fast lane to value-based care. Fee-for-service? On the way out. Say hello to the new risk-based, population health model of care. It’s coming. Fast. And in order to get there, you’re going to need to make the most of your data. From all your disparate data sources – EHRs, labs, clinical, claims, manual, you name it. Forward Health Group’s PopulationManager® is your MACRA on-ramp – we’ll make sure you fast forward to value-based care. And maximize your returns.
MACRA has created two tracks of payment: Advanced Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). Which route to take? APM or MIPS?
What is MIPS?
MIPS is part of MACRA’s new program which combines qualities of the Value Modifier (VM or Value-based Payment Modifier), the Physician Quality Reporting System (PQRS) and the Medicare Electronic Health Record (EHR) into a singular program that measures eligible clinicians based on the following:
- Clinical Practice & Improvement
- Resource Use
- Efficient Utilization of Certified EHR Technology
What are APMs?
Alternative payment models allow patients to identify new ways to pay for care provided by health care professionals to Medicare beneficiaries. For example, from 2019 to 2024, APMs will allow patients to pay some health care providers a lump sum payment.
It also helps in increasing the transparency of payment models in regards to physicians. This model will also offer some providers substantially higher annual payments.
Is MIPS for you?
With MIPS, physicians will be paid based on four criteria: quality, advancing care information, clinical practice improvement, and cost/resource utilization. How well a physician scores in these categories will determine how much they will be paid.QualityEssentially, this is a modified version of Physician Quality Reporting System (PQRS). Physicians are allowed to select six quality criteria from a list of options specific to practices. They will use these criteria for reporting. Currently, physicians are required by PQRS to report on a total of nine quality criteria.Clinical Practice Improvement ActivitiesTo be eligible, physicians need to score at least 60 points in this category by becoming involved in programs that will help improve their practices in measures, such as patient engagement, patient safety, and care coordination. CostThis category has taken the spot of the value-based modifier. CMS will calculate scores straight from Medicare claims without direct involvement from physicians.
Or is APM better suited?
It’s expected that a significant number of healthcare providers will be eligible for the APM mode of payment after the first year. From 2019 to 2024, clinicians who are participating in APMs are entitled to receive a lump sum payment of 5% of their previous year’s Medicare Part B payment. APMs include payment models, such as Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).
For APMs to qualify, MACRA rule states that they have to meet three criteria:
- Physicians and medical care providers must use certified Electronic Health Record (EHR) technology.
- APMs should pay clinicians based on quality measures that are comparable to those used in MIPS quality performance category.
- Physicians must participate in risk-sharing, such as part of an ACO-type arrangement, or be an accredited PCMH.