By Robin Diamond, MSN, JD, RN, Senior Vice President of Patient Safety and Risk Management, The Doctors Company
In January 2017, the beginning of the first performance reporting period for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), only 19 percent of physicians reported that they were very or somewhat familiar with MACRA.
Physicians and practice managers may feel as if they're being left at the starting line, but there is still time to get in the MACRA race.
On your mark...
- Assemble a team. A team is vital to tackle MACRA data collection, data analysis, and submission. Team members should come from various roles in the practice and brainstorm strategies to incorporate metrics into existing workflow and optimize the workflow to include data collection.
- Decide whether to report as a group or individual. An individual is defined as a single National Provider Identifier (NPI) tied to a single Tax Identification Number (TIN). A group is defined as a set of clinicians (identified by their NPIs) sharing a common TIN, regardless of their specialty or practice site. Know the criteria, advantages, and disadvantages of reporting in each category -- the Quality Payment Program (QPP) website is a helpful resource.
- Pick your pace. Practices have four options to choose from and can participate as much, or as little, as they choose. It is points-driven: The more participation, the more points earned. The goal is to exceed 70 percent in the composite score to be considered for a bonus. The composite score is composed of Quality + Advancing Care Information + Improvement Activities. Understand your participation options.
- Select measures and submission methods. Choose measures that best fit your practice. Understand that not all of the measures are equal in value. Under the quality category, one measure could earn as many as 10 points. Take time to review your options.
- Review and improve. Evaluate past performance in the Physician Quality Reporting System (PQRS), which now becomes the Quality Measures and will have the greatest weight (60 percent of the composite score).
Review past performance in the Meaningful Use (MU) measures. MU now becomes Advancing Care Information (ACI) and will require greater participation than in the past.
A new performance category for 2017 is the Improvement Activities (IA). Most groups will attest to completing four activities. Small groups with less than 15 physicians will attest to two activities. These activities focus on patient safety, care coordination, and engagement.
- Start now. If you're not reporting yet, there is still time to start before October 2, 2017 -- and the earlier the better. Reporting a single measure will avoid a negative adjustment in 2019. At least 90 consecutive days of data is required to be considered for a positive upward or neutral adjustment. What is done this year will reflect in the 2019 public reporting and pay-for-performance. Delaying participation may make next year more challenging.
For more information, go to the Medical Advantage Group website or contact The Doctors Company Patient Safety Department at firstname.lastname@example.org.
With contributions from Kim Hathaway, Healthcare Quality & Risk Consultant, The Doctors Company