The Centers for Medicare and Medicaid Services (CMS) finalized the Medicare Access and CHIP Reauthorization Act (MACRA) in 2016 and is effective 2017 onwards. While the CMS met its goal of 30% value based payments in 2016, by 2018, the agency intends to bring it up to 80%.
What is MACRA?
Orthopedic practitioners fall under two categories within MACRA. The first is the MIPS (the Merit-Based Incentive Payment System) (MIPS) and the second is the APM (Alternative Payment Models). Practitioners have to start reporting in 2017 while the payment will begin in 2019 based on the stream chosen by the doctors.
MIPS combines the former MU (Meaningful Use), PQRS (Physician Quality Reporting System), and VBPM (Value Based Payment Modifier). Each category of quality, use of resource, advancing care information and clinical practice improvement are given different weightage under MIPS.
The second choice is the APM model where doctors take the “more than nominal risk for the cost and quality of the care they provide.” The payment in APM model is also similar to MIPS where quality and compensation are linked to each other directly.
Orthopedic practitioners can opt out of MIPS if they meet certain criteria of patient volume and revenue. Other than these, the eligibility criteria for APM also includes:
• Using quality measures similar to those specified in MIPS
• Using a certified EHR or electronic health record technology
EHR Solutions from Centricity Practice Solution
Quality scores are the foundation of MACRA and orthopedic practitioners need to focus on quality to stay ahead of competition. Besides maintaining stringent quality, reimbursement cuts are another major challenge that most orthopedic practices are dealing with. Upgrading to newer technologies and solutions are mandatory to minimize the reimbursement cuts. Practices using analog technologies will face a 20% reduction in reimbursement in 2017 while 7% cut in reimbursement will be faced by those using computed radiography.
To meet either MIPS or APM criteria, many small, private orthopedic practices may be inadequately staffed to carry out the exhaustive outcomes and other data.
Centricity Practice Solution has the most comprehensive Electronic Health Record technology that can take over the data management for private orthopedic practices. To be ready for MACRA, quality improvement with intelligent data collection, organization and analysis are critical areas to focus on. Orthopedic practitioners also can meet the eligibility criteria for either payment track– MIPS or advanced APM with certified technology such as GE Healthcare’s certified electronic health record, Centricity™ Practice Solution.