AMA Releases MIPS Action Plan and Expanded Toolset

Ken Terry

August 15, 2017

The American Medical Association (AMA) has released the latest addition to an extensive toolset designed to aid physicians in grappling with Medicare's Quality Payment Program (QPP), which was authorized by the Medicare Access and CHIP Reauthorization Act (MACRA).

The new tool is a customizable Merit-based Incentive Payment System (MIPS) Action Plan that can help physicians meet the requirements of MIPS, one of QPP's two tracks. The AMA also offers a short video, titled "One patient, one measure, no penalty: How to avoid a Medicare payment penalty with basic reporting." This video comes with a step-by-step guide and a CMS-1500 claims form showing an example of MIPS quality reporting.

Among other tools in the AMA toolset are:

  • A link to an eligibility tool from the Centers for Medicare and Medicaid Services (CMS) that physicians can use to find out whether they're eligible for MIPS.

  • An online MACRA assessment, the Payment Model Evaluator, that physicians can fill out to determine MACRA's impact on their practice and their payment model options.

  • A Quality Measure Search tool that helps doctors find relevant quality measures to report on, as well as the CMS specifications for those metrics.

  • A MACRA timeline showing important upcoming deadlines for QPP.

  • Detailed information on QPP, including a podcast series and downloads of relevant AMA papers.

  • "A Guide to Physician-Focused Alternative Payment Models," prepared by AMA and Center for Healthcare Quality and Payment Reform.

  • How-to articles on evaluating pay-for-performance (P4P) contracts and bundled payment contracts.

A recent survey conducted by the AMA and KPMG showed that the majority of physicians are unprepared to participate successfully in MIPS, despite the "pick your pace" transitional approach that CMS adopted for 2017. Physicians who have not previously participated in Medicare reporting programs are particularly in need of basic information to take steps this year to avoid a payment penalty in 2019, the association said.

"The lack of preparedness for these important Medicare changes is particularly acute for physicians in smaller practices," said AMA President David O. Barbe, MD, in a news release.

Burdensome Process

In contrast to the findings of the AMA/KPMG survey, a recent survey from the Medical Group Management Association (MGMA) found that 84% of practices were participating in MIPS; 72% had reported more than the minimum amount of data to avoid a financial penalty; and 41% were fully reporting MIPS data this year.

Among the 750 group practices that responded to the MGMA poll, nearly 80% were independent practices. Thirty percent of the groups included one to five full-time doctors, and 37% had six to 20 full-time physicians.

Despite the relatively high MIPS participation rate, however, more than 80% of the respondents said that complying with the program was very or extremely burdensome.

The AMA news release and the website pages describing the MACRA tools made it clear that AMA fully supports MACRA, as it did when the bill was being debated by Congress. In making the case for physicians to prepare for MIPS and alternative payment models, the associated noted, "By 2023, upwards of 80% of healthcare could be delivered under value-based payment models."

In the section explaining MIPS, the AMA pointed out, "Without the passage of MACRA, physicians could have been subjected to negative payment adjustments of 11% or more in 2018 as a result of Meaningful Use, the Physicians Quality Reporting System, and Value-based Modifier reporting programs — with even greater penalties in future years. In contrast, under MACRA, the largest penalty a physician can experience in 2019 is 4%."

"Change has arrived," Dr Barbe said in his statement. "We know that change does not happen overnight or without challenges and the AMA is working to help physicians through this transition, both through our work to ease regulations and to provide physicians with tools to help them be more successful."

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