The rules are complex. The legislation is dense. How are providers supposed to cut through the highbrow language and get to the core of what’s required to meet MACRA standards? Don’t worry – there’s no need for concern because we did that for you. In this article, we’ll break down some of the main points and give you quick links right to the CMS tools you’ll need to be successful in fulfilling your quality care measures.
The 3 Criteria of Macra guidelines
At the heart of MACRA, you have a quality payment program (QPP) called MIPS. Short for Merit-based Incentive Payment System, MIPS outlines four areas from which healthcare professionals will be assessed and granted payment increases. The four areas are Quality, Improvement Activities, Advancing Care Information, and Cost. “But the header said, ‘3,’” you say? Quality, Improvement Activities, and Advancing Care Information measures will factor into the calculation of payment adjustments in 2017, while Cost doesn’t come into play until the following year. Until then, healthcare professionals will be given a score out of 100 to evaluate their participation, weighted as 60% Quality compliance, 15% Improvement Activity compliance, and 25% Advancing Care Information compliance. It’s also worth noting that there are no submissions required of the provider to meet Cost criteria; it’s calculated from adjudicated claims information.
Let’s break down the three criteria you need to focus on most:
Quality measures, as defined by MACRA, are used to evaluate the care administered by providers. Each specialty has a number of procedures on which they can be evaluated, so providers can pick out care options that they regularly administer and report on those. To meet MIPS requirements, participants must “report up to 6 quality measures, including an outcome measure, for a minimum of 90 days” (qpp.cms.gov). CMS supplies participants with a web tool that allows them to download their choice of relevant and eligible measurements on their website – click here to go there now. Users can filter through over 250 different measures by choosing their report submission method and their practice. When the list is narrowed down, the user can then add as many reports as needed to a download queue and get them all at once. Every download features a description of the measure and other details providers will need to fulfill the reporting requirements.
Next on the list is the Improvement Activities category, which consists of different reports that indicate the provider, practice, or facility is taking steps to change the way they deliver care and maintain patient records. The subcategories, which include selections like Behavioral and Mental Health, Care Coordination, and Patient Safety & Practice Assessment, further describe the types of activities providers will need to follow. Providers can meet Improvement Activities criteria if they “attest that you completed up to 4 improvement activities for a minimum of 90 days” (qpp.cms.gov). While the other categories of MIPS reports may look familiar because they replaced older incentive programs, Improvement Activities is new altogether. Providers who skip out on Improvement Activities will only be missing out on 15% from their total score, but the higher the score, the better the payment rate adjustment. Improvement Activities also keep professionals aware of the best ways to meet the other criteria, so it’s a good idea to follow along. To find a list of the available Improvement Activities, click here and use the featured web tool.
Advancing Care Information
The final criteria for the 2017 evaluation period is Advancing Care Information (ACI). The ACI category (which we’ll remind you accounts for 25% of providers’ total MIPS scores), is almost entirely dependent on the use of technology in a practice environment. In other words, meeting the ACI criteria means demonstrating that the facility or practitioners have integrated and actively use EHR technology in daily work. In fact, there are some measures that can really only be accomplished by leveraging EHR use, such as Providing Patient Access or e-Prescribing. There are probably workarounds to accomplish these actions, but they’re likely difficult to achieve and costly, considering EHR vendors already have reliable products available. Doctors must submit five core measurements, found here, and then they can “submit up to 9 measures for a minimum of 90 days for additional credit” (qpp.cms.gov). Activities like using a certified EHR system and reporting Public Health and Clinical Data Registry Reporting measures will also reward providers with extra credit. Considering that there are a couple of bonus opportunities, it’s clear that the move to adopt EHR technology is an underlying motivation of the MACRA program. For more information on all of the measures that fall under the ACI category, click here.
The Toughest Part?
With the majority of healthcare professionals reporting that they have encountered some kind of difficulty in using EHR systems, it remains to be seen whether these dated software applications will help or hinder practitioners from meeting the required MIPS criteria. Steps have been taken to address the usability woes of EHR systems, however, with the introduction of mobile EHR apps. These apps enable more intuitive functionality on devices like smartphones and compact tablets, devices that are more user-friendly in the exam room and on the go. The best mobile EHR apps connect directly with underlying EHR systems that have been approved for use under MIPS, so they could prove to be valuable tools to providers during the first reporting period in 2017.
For more information about the introduction of these mobile apps and how they’re properly equipping physicians to meet Quality and ACI criteria simultaneously, click here to download a free resource, The Ultimate Guide to Mobility in Healthcare.