MACRA And MIPS: Preparing For Changes
By Bhupender Singh, CEO, Intelenet Global Services
The Medicare Access and CHIP Reauthorization Act (MACRA) was passed with bipartisan support in 2015. The act promises to fundamentally change the way the U.S. evaluates and pays for healthcare by repealing the Sustainable Growth Rate (SGR) Formula that has determined Medicare Part B reimbursement rates for physicians and replacing it with new ways of paying for care. Under MACRA, participating providers will be paid based on the quality and effectiveness of the care they provide.
It has been estimated more than 800,000 physicians will be excluded from MACRA reporting for 2017, while approximately 500,000 physicians still need to submit Merit-based Incentive Payment System (MIPS) data. MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-Based Payment Modifier) and the Medicare Electronic Health Record (EHR) incentive programs into one, and will be used to determine whether providers’ compensation for Medicare Part B reimbursements is adjusted up for superior performance, or down for performance that falls short of the established mean.
Among health providers being entered into the MIPS program, it is reported 64 percent feel “unprepared” for managing and executing MACRA initiatives. This is a significant number of health providers currently not prepared to take on these upcoming changes.
Given the complexity of the legislation and the speed with which it was passed through Congress, it is no surprise a significant number of physicians are struggling to implement various aspects of the legislation. The law promises to provide clinicians with more flexibility in the way they practice, while in return requiring more accountability for quality and cost. The challenge will be to successfully implement this newfound way of practicing medicine and how these features of the legislation are implemented. This is expected to have a major impact on not only clinician payment, but also on further developments in healthcare organizations.
Many practices are still operating using a fee-for-service method, making it essential to transform current operating methods. Cost efficiency, patient service, collections, and accelerated service should continue to remain the primary focus of healthcare institutions.
As it stands now, there are a number of requirements and implications for physicians to be aware of. First, to succeed under the new rules, physicians will need to collaborate with their larger health networks to start thinking of efficient ways to measure individual performance. They will not only need to become accustomed to being measured in this way, but also with the idea their performance will be available to consumers as centers for Medicare and Medicaid Services (CMS) move towards using a system of transparency to improve performance.
Secondly, as fee-for-service reimbursements will be shifted away from and physicians, they will need to consider how this will affect their financials. The shift in reimbursement from a quantity to quality service model might initially be stunting for business. Under MIPS there is also potential for penalties to accrue over the years. The new system will, however, benefit health providers who score highly. For those that do, they will be eligible for a 27 percent payment bonus.
Finally, the analytic platforms currently employed by some healthcare providers do not have the capacity to track improvement activities and workflows required by the MACRA legislation. Healthcare providers will need capable platforms to track these activities and show how they have been able to improve their practice and their quality of care.
It is essential providers and physicians that are unsure how to fully implement MACRA partner with an expert that can design, launch, and manage the processes seamlessly and effectively. Doing so will ensure the administrative burden is kept to a minimum and the practices required to implement MIPS are carried out correctly.
AI solutions that use natural language processing can also simplify some of the most complex transactions in healthcare revenue cycle management by extracting the accurate code and returning a reduction in cost of coding. The system to code and classify all diagnoses, symptoms, and procedures recorded in conjunction with hospital care is vital to all healthcare practices, so it is recommended to partner with a specialist that employs AI solutions. Providers not fully prepared for MACRA will inevitably have to carry out these processes manually which can result in limited time for research and inflated costs of operations.
When finding a partner, it is essential to help them prepare for the demands of the legislation, and that physicians and healthcare practices work alongside a provider that can tap into future-ready technology, developing services or solutions that reach beyond the product to drive better outcomes for patients, while improving the efficiency of care delivery for providers.
About The Author
Bhupender is CEO of Intelenet Global Services. He is responsible for managing Intelenet’s global business portfolio across U.S., U.K., Europe, Middle East, India, and Philippines. He serves as the leader responsible for setting the course for achieving Intelenet’s long-term vision, through organic and inorganic initiatives, investment in new market entry & enabling technology, and people and client engagement.