Healthcare is shifting to value-based care and CMS is paying practices on their ability to meet certain quality measures under Medicare Access and CHIP Reauthorization Act of 2015.
Under MACRA, physicians can participate in the Merit-Based Incentive Payment System or the Alternative Payment Models. MIPS consists of a weighted score of quality, resource use, meaningful use and practice improvement scores. Starting 2019, practices will either face penalties or bonuses for meeting MIPS standards, and those practices aiming to excel need to master four MIPS areas, according to Medical Economics.
Here are four areas to know:
1. Quality. Under this measure, physicians will choose six measures that work within their practice or specialty. Of these six measures, one has to be an outcome measure that is applicable across all specialties. Physicians therefore should carefully evaluate which measures they will use to obtain the highest quality score. Data analytics may provide concrete data supplying practices the information necessary to make informed decisions.
2. Advanced care information. ACI is replacing Meaningful Use, giving practices measures that prioritize the information exchanges, security and interoperability. To meet these standards, practices should ensure their electronic health records are communicating well with other systems and have all the necessary security measures. ACI emphasizes patient engagement and therefore will measure whether practices are electronically sharing their information with patients. Experts suggest practices continue to use their patient portal and other systems they implemented under MU.
3. Clinical improvement activities. Under MIPS, practices can choose from among 90 activities that will measure areas such as care coordination, beneficiary engagement and patient safety. Clinical improvement activities include measures such as a diabetic's hemoglobin A1C control and medication adherence. Under this measure, physicians can obtain credit for one activity and can apply for credit for other measures. Eric Schneider, MD, senior vice president for research and evaluation at The Commonwealth Fund, said practices should focus on activities that directly relate to their practice to do well under this MIPS component.
4. Resource use & cost. CMS added more than 40 episode-specific measures to MIPS after many medical professionals claimed CMS was not accounting for measures that accurately depicted the type of care they provided. To effectively use resources, providers should examine their most recently-use codes and ask patients to bring their explanation of benefits to their appointments.
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