For healthcare practice owners and managers, understanding and navigating the Medicare Access and CHIP Reauthorization Act (MACRA) and the Merit-based Incentive Payment System (MIPS) is crucial.
These systems not only govern how Medicare payments are adjusted but also provide a framework for quality improvement and cost efficiency in patient care.
Here, we explore MACRA & MIPS best practices, which can lead to enhanced patient outcomes and potentially increased Medicare reimbursements.
Understanding MACRA and MIPS
First, it’s important to grasp what MACRA and MIPS entail. MACRA, enacted in 2015, replaced the Sustainable Growth Rate formula, which previously controlled payments for healthcare providers’ services.
Under MACRA, MIPS was introduced as one of the pathways for payment, emphasizing a pay-for-performance approach across four performance categories: Quality, Cost, Improvement Activities, and Promoting Interoperability.
1. Quality
This category replaces the former PQRS (Physician Quality Reporting System) and accounts for 45% of the total MIPS score. Practices should focus on selecting measures that reflect their most frequently provided services or where significant improvements in care and outcomes can be achieved.
Best Practices:
Select Measures Wisely: Choose measures that are highly relevant to your practice and where you already perform well or can show measurable improvement.
Use Data Analytics: Implement healthcare analytics to track and improve performance on these measures continuously.
2. Cost
The cost category, accounting for 15% of the total score, is assessed by CMS without requiring data submission. It is calculated based on claims and is intended to gauge the total cost of care during the year or during a hospital stay.
Best Practices:
Understand the Attribution: Determine which patient costs CMS will attribute to you and understand the factors driving those costs.
Focus on Care Coordination: Improve coordination of care, which can reduce redundant services and associated costs.
3. Improvement Activities
Worth 15% of the total score, this category rewards practices for care coordination, patient engagement, and patient safety. Most practices find this category the easiest in which to improve their score because many are already engaging in these activities.
Best Practices:
Document Activities: Keep detailed records of all your improvement activities. This documentation will be invaluable during attestation and can protect against audit issues.
Align Activities with Organizational Goals: Choose activities that align closely with your practice’s operational goals or that address specific patient needs in your practice.
4. Promoting Interoperability
Formerly known as the Advancing Care Information, and before that, Meaningful Use, this category focuses on patient engagement and data exchange and is worth 25% of the total MIPS score.
Best Practices:
Invest in Technology: Ensure your Electronic Health Records (EHR) system meets the requirements for health information exchange, patient access, and other interoperability aspects.
Train Your Staff: Regular training on the EHR and EHR software solutions can help in achieving higher efficiency and better data management, ensuring compliance with MIPS requirements.
Strategic Planning and Reporting
Developing a MIPS Strategy
How to improve practice with MACRA & MIPS?
Each component of MIPS requires a tailored strategy that aligns with your practice’s strengths and areas for improvement.
The best strategies for MACRA/MIPS:
- Perform a Gap Analysis: Identify where you are versus where you need to be on MIPS measures and work systematically to close those gaps.
- Engage Your Team: MIPS is not a one-person job. Engage doctors, nurses, administrative staff, and IT personnel in your MIPS strategy.
Accurate and Strategic Reporting
Submitting data to MIPS is a strategic decision that should be made with careful consideration of which measures to report and how to report them.
- Opt for Full-Year Reporting: While a 90-day reporting period is allowed, a full-year reporting offers a broader data set, which can help in smoothing over any anomalies in performance.
- Leverage MIPS Qualified Registries: These registries can help gather, calculate, and submit your MIPS data, ensuring accuracy and compliance.
Continuous Improvement
Ultimately, the importance of MACRA/MIPS lies not just in avoiding penalties but also in fostering an environment of continuous improvement in healthcare practices.
- Foster a Culture of Quality: Cultivate an environment where every staff member is conscious of their impact on care quality and is motivated to improve.
- Regularly Review Performance Data: Regularly reviewing performance data allows for real-time adjustments and long-term planning.
Wrap Up
By integrating these best practices into your healthcare practice’s operational strategy, you can not only comply with MACRA and MIPS requirements but also significantly enhance patient care and financial performance. Remember, success in MIPS is about more than just compliance; it’s about setting a standard for excellence in healthcare.
