The MACRA Era
Welcome to the 21st Century Practice
Ever wonder how much less complicated practice would be without all of these fastballs coming at you?
What fastballs you may be asking? HIPAA, OSHA, MACRA, Medicare standards—the environment DCs practice within today is much more complicated than it was over 25 years ago.
However, the major difference today is this: DCs have risk but they also have great opportunity to participate in the 21st century of healthcare. The new payment system, the MACRA law, has now ushered in the context of the value-based, patient-focused system of reimbursement. Medicare and commercial payers have begun the process of transition.
But are you ready to be a 21st century practice?
Why MACRA matters
The MACRA law (Medicare Access and CHIP Reauthorization Act of 2015) singlehandedly will move healthcare in the U.S. into value-based care delivery. Doctors of chiropractic, once registered as a Medicare provider, may not opt out of being a provider, unlike other physicians.
An “opt out” refers to a physician’s ability to decide not to bill Medicare at all, thereby allowing the ability to enter into private contracts with the Medicare beneficiaries they treat.
In addition, unless you meet the low volume threshold ($30,000 or less in allowed charges or 100 or fewer unique Medicare patients annually) or are involved in an advanced APM or have only been practicing for a year; no eligible clinician can “opt-out” of MACRA.
Central to the success of a practice in the new payment model, is the ability to report and stay complaint with the new system. And by the way, the low volume threshold will continue to lower to capture more providers over time.
Making sense of MIPS
MIPS is a federal quality program that combines three quality incentive payment programs, the Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VBPM), and Meaningful Use (MU) of Certified Electronic Health Records Technology (CEHRT), into a single quality incentive payment program.
The current incentive programs will be combined and a composite threshold performance score (scale of 0 to 100) established aimed at informing providers of the levels of reimbursement based on four key performance measures: Advancing Care Information (formerly Meaningful Use), Quality (formerly Physician Quality Reporting System—PQRS), Resource Use (formerly Value-based Payment Modifier—VBPM) and a new category calledImprovement Activities (IAs).
This new performance area focuses on what you are doing in your practice to improve your care. There are 90+ activities that have been identified and providers are given an opportunity to select those that are most appropriate for the services they provide. Note that the law allows certified patient-centered medical homes (PCMHs) and, more recently, patient-centered specialty practices to receive pre-validation for all 15 points assigned in the CPIA category.
Here’s how it works: You’ll receive a MIPS “composite performance score,” which is based on your performance in the above four key areas. The score will dictate annual payment adjustments— either positive or negative. Your individual MIPS score will be compared to a performance threshold to determine how Medicare will adjust your payments each year. Only those scoring on the threshold will receive no adjustment.
The performance threshold has been set at 3 for the transition year of 2017 due to the flexibility provided by CMS to engage providers. A score of 70 will gain providers access to the bonus funds in 2017.
Upward or downward payment adjustments will be made on individual Practices score. But MIPS has to be budget-neutral, so CMS will pay for all of the positive payment adjustments with money it gains from negative payment adjustments.
Why data matters to your practice
You have access to a lot of information—from your patients, collections, and even your staff. You may not think it’s important to both collect and use this data, but it is, especially with changes coming across the horizon.
With the advent of the new payment system beginning January 2017, for Medicare, providers will be playing an important role in performing key clinical activities known as quality measures, which will be monitored by third-party payers and rewarded through pay-for-performance models. Clinical data must be collected and reported to help practices achieve a higher rate of reimbursement and better management of the practice’s patient population health.
The kind of data that chiropractors can collect is, well, a lot. But don’t let it overwhelm you as there are companies and organizations that can collect the data for you. But you need to know what kind of data you can (and should) be examining.
Key performance data for chiropractors includes financial, operational, and clinical data. Financial data is your patient accounts receivable in the billing systems administered via your practice management software, in addition to a separate accounting or bookkeeping system that manages the practice’s revenue and expenses, payroll, and pertinent financial reports. Operational data comes directly from your practice management soft- ware and tells the story of the statistics in your practices—new patients, patient visits, dollars collected averaged per patient visit or case, charges per patient visit or case, and more.
What does your QRUR mean?
What you will see on your Quality Resource and Use Report (QRUR) is your Medicare report card, which is a report of both the PQRS measures and the cost composite of your patients. The cost component is where the value based modifier program (VBM) comes into play. This report card shows how groups and solo practitioners, as identified by their TIN, performed in 2014 on the quality and cost measures used to calculate your 2016 Medicare reimbursements. Establish your Enterprise Identity Data Management (EIDM) for access to the CMS portal and ability to download provider reports.
What you will see on your Quality Resource Use Report (QRUR) is a report of both the PQRS measures and the cost composite of your patients. The cost component is where the value based modifier program (VBM) comes into play. a subset of measures included in the VBM.
Solo physicians and small group practices, who do successfully report to PQRS in 2016, will receive a neutral payment adjustment.