MACRA for Busy Docs: 12 Things to Know

Leigh Page

Disclosures

September 07, 2016

In This Article

Progress May Be Slow for Physicians

6. Many Clinicians Could Languish in the Basic Track for Years

Most ECs will be in MIPS, which is envisioned as a kind of boot camp to prepare for APMs. Owing to the shortage of opportunities to enter advanced APMs, however, most clinicians could stay in MIPS for many years to come.

"A number of medical societies are developing models for advanced APMs, but we don't know whether or when they would be approved by CMS," Miller says. "The innovation center is taking too long."

The expectation is that MIPS will help clinicians get used to collecting performance metrics and starting to use them in their practices. ECs will be in reporting programs that are mostly altered versions of existing Medicare reporting programs.

The Physician Quality Reporting System (PQRS) will become the MIPS Quality category, MU becomes MIPS Advancing Care Information (ACI), and the Value-Based Payment Modifier (VBPM) becomes MIPS Resource Use.

In addition, there will be a new MIPS reporting category, called "clinical practice improvement activities," in which physicians are expected to carry out changes in their practices that are chosen from a list of more than 90 possible activities, such as same-day appointments, telemedicine, and patient engagement.

Initially, quality will be the most important MIPS measure, accounting for 50% of the total score, although that share will decline to 30% by 2021. Also, in the transition to MACRA, quality reporting will shift from clinicians being graded simply for reporting measures under PQRS to being graded for performance on those measures under MIPS.

7. Outcome Reporting Will Now Be Required

PQRS focused on reporting process measures, but the MIPS Quality category will require reporting at least one outcome measure.

PQRS process measures included such activities as reporting the percentage of patients with coronary artery disease who were prescribed aspirin or clopidogrel. There have also been a small number of outcome measures, such as the percentage of patients who require intubation after coronary artery bypass graft surgery, but they are not required under PQRS.

Under MIPS, however, physicians will have to choose one quality measure out of a total of six measures to report. CMS has been using measures approved by the National Quality Foundation (NQF), which include about 70 outcome or intermediate outcome measures, compared with more than 180 NQF-approved process measures, according to a list[4] provided by CMS.

The NQF list has many gaps. For example, 11 specialties have only one outcome measure to choose from, and primary care has only four. However, CMS plans to expand the available quality measures under MIPS by using a list created by the Core Quality Measure Collaborative, a group that includes representatives from CMS, private payers, medical societies, and patient groups.

Furthermore, CMS intends to update core measures annually in a process that will involve submitting new measures for publication in peer-reviewed journals and posting the new measures in the Federal Register.

The NQF outcome measures may not be very difficult to attain. For example, the NQF measure for diabetes states that a certain percentage of your patients must have a A1c value of less than 9%. That allows "some wiggle room" for clinicians, because the usual goal for most patients with diabetes is the much tighter value of less than 7%, according to Kevin M. Pantalone, DO, an endocrinologist at the Cleveland Clinic.

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