The Medicare and CHIP Reauthorization Act of 2015 (MACRA) represents a sea change from the SGR formula to a value-based reimbursement. A Monday clinical symposium discussed the new payment system and what physicians and practice managers in rheumatology practices can do to prepare.
“This legislation actually had bipartisan support, so unlike the Affordable Care Act, which has an uncertain fate at this point, I think MACRA is likely here to stay,” Jinoos Yazdany, MD, MPH, Associate Professor of Medicine at University of California, San Francisco, and Chair of the ACR Research and Publication Subcommittee, said during the ACR/ARHP session Implementing Quality Measurement In Your Practice: How and Why.
MACRA streamlines three existing quality reporting programs — the physician quality reporting program (PQRS), value-based payment modifier, and Medicare electronic health records incentive program — into the merit-based incentive payment system (MIPS), Dr. Yazdany said.
MIPS relies on Qualified Clinical Data Registries (QCDR) to report performance measures to Centers for Medicare & Medicaid Services, and RISE, which stands for Rheumatology Informatics System for Effectiveness, is a QCDR developed by ACR.
There is also a second payment track under MACRA, the alternate payment models (APMs), but the symposium focused on MIPS because “there are very few examples of rheumatology practices that are going to be part of APMs,” which are more appropriate for larger practices, Dr. Yazdany said. Either way, individual providers or groups of providers have until March 31, 2018, to submit their performance data to be eligible for incentives or face penalties.
In this first year of the program, the bar to avoid the penalty of 4 percent negative payment in the MIPS system will be very low, requiring the reporting of only a single measure.
“Just engaging in this program in some way will avoid the penalty, but this will get less lenient,” Dr. Yazdany said, adding that, “an analogy of a treadmill is appropriate here because as you can see this will move faster and faster and you want to get on at the very beginning.”
Alex Limanni, MD, Rheumatologist at the Arthritis Centers of Texas in Dallas, explained the outcome measures that determine a MIPS score, which is based on a 100-point scale. The measures fall into four basic domains: Quality improvement measures; advancing care information, which are essentially the meaningful use measures; clinical practice improvement activities; and quality resource use and utilization reporting.
Dr. Limanni focused his talk on the latter two measures that are not well understood or well defined, yet. The clinical practice improvement activities (CPIA) will account for 15 percent of the MIPS score, and there is currently a menu of 90 activities in categories of patient access to care, patient satisfaction, use of telehealth, among others. The quality resource and utilization reporting will not contribute to the MIPS score in the first year, but it will eventually account for 10 percent of the score.
“To put in a plug for RISE, if you are using a QCDR, you are getting points at almost every end of the MIPS system both the meaningful use and quality as well as these kinds of CPIA activities,” Dr. Limanni said.
An advantage for rheumatologists using RISE is that it contains rheumatology-specific measures. For rheumatoid arthritis, for example, it has measures for disease activity, functional status assessment, latent TB screening, and DMARD use.
Catalina Orozco, MD, rheumatologist at Rheumatology Associates in Dallas, walked through how her practice began to implement RISE. Much of the information she and her colleagues enter in the electronic medical records is in structured fields, but certain outcomes such as disease activity are entered in non-structured fields, making it harder for RISE to capture. To deal with this problem, she and her colleagues enter that information in structured fields in a separate lab report.
Dr. Orozco recommended assigning a clinician for the initial process of setting up and mapping the data and for clinics that store their data off-site to obtain special permission to access it. During the question period, a representative from the RISE Registry said that they have been able to connect with certain CLOUD based data sets.
“A lot of people are participating now in RISE, we have a nice steady uptake of the registry, and at this point there are 774,000 distinct patients with over 3 million encounters,” Dr. Yazdany said.