MACRA for Busy Docs: 12 Things to Know

Leigh Page


September 07, 2016

In This Article

More Monitoring of Clinical Activities

8. Your Use of Clinical Resources Will Be Monitored

Under MIPS, CMS will be stepping up surveillance of your use of clinical resources, such as ordering tests and admitting patients to the hospital.

Like the current VBPM program, MIPS Resource Use won't require any reporting by ECs because it is based on Medicare claims data. CMS will evaluate performance using attribution logic similar to what is now used by VBPM, according to a report[5] by HDJN, a health law group in Richmond, Virginia.

Here's how the data will be evaluated, according to HDJN: CMS will ascertain the total per capita cost for all Medicare beneficiaries attributed to you, and from that it will calculate a Medicare spend per beneficiary measure; it will also calculate new condition and episode-based measures, which were not used in VBPM. Then it will adjust data to reflect differences in geographic payment rates, beneficiary risk factors, and physician specialties.

Resource use, which is all about the cost of services, will become increasingly important in your overall MIPS score. It starts at 10% of your score and rises to 30% by 2021.

9. Meaningful Use Stages Will Continue for Now

Even as MU morphs into ACI, its stages will continue, Fulton says. He says 2017 has been deemed an "optional year" when physicians can used either the 2014 edition of MU, which features stage 2, and the 2015 edition, which features stage 3. "You don't have to use stage 3 until the beginning of 2018," he says.

Stage 3 has two fewer objectives for your base scoresix objectives instead of eight—but if you're still working on stage 2 next year, you will still have to report the eight measures, Fulton says.

Physicians have roundly disliked stages 2 and 3, and stage 3 is said to be the most challenging of all. It may change in the final rules, and after that, the stages may end, although no announcement has been made, says Bruce Hamory, MD, chief medical officer in the Health and Life Sciences Practice at Oliver Wyman, a management consulting firm based in Chicago.

In another portion of the new ACI program, clinicians will report three performance measures—patient electronic access, coordination of care through patient engagement, and health information exchange—and one bonus point will be awarded for reporting data to public health and clinical data registries, he says.

Also, ACI will replace the all-or-nothing scoring under MU with graduated scoring, which will conform to the scoring for other MIPS measurements.

Meanwhile, CMS is pushing hard for interoperability. Dr Hamory says the Office of the National Coordinator for Health Information Technology has organized a work group made up of the major vendors to work out standards for transmitting information. "But this is a great challenge, and it may take years to make systems totally interoperable," he says.


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