November 10-15

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ACR Convergence 2023

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Home // Tips to get paid: Session provides updates on MACRA, MIPS, and APMs

Tips to get paid: Session provides updates on MACRA, MIPS, and APMs


4 minutes

Angus Worthing, MD, FACR, FACP
Angus Worthing, MD, FACR, FACP

The year 2019 was the first year where rheumatology practices saw their Medicare reimbursement amount affected by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and its Merit-Based Incentive Payment System (MIPS).

Just exactly how that system is working out will be the topic of discussion during the Clinical Practice session Get Paid: Update on MACRA, APMs, and MIPS Tips taking place in Room B218, Building B of the Georgia World Congress Center on Tuesday from 1:00 – 2:00 pm.

“MACRA modifies doctors’ payments for people aged 65 or older in the Medicare system and it gets tweaked every year,” said ACR Government Affairs Committee Chair Angus Worthing, MD, FACR, FACP, a rheumatologist at Arthritis & Rheumatism Associates, PC, in Washington, DC, and Clinical Assistant Professor of Medicine at Georgetown University Medical Center, Washington, DC. “During this session we want to update attendees on what happened in 2019 in terms of reimbursements, bonuses, and penalties, and provide updates on newer proposed changes.”

Quality Payment Program

Dr. Worthing will open the session with an overview of MACRA expectations and MIPS progress during the past year.

First, he will provide a detailed update on the first year of reimbursement bonuses and penalties in the Quality Payment Program (QPP). The first MIPS performance year was 2017, with payment adjustments accrued from that year applied to Medicare Part B reimbursements beginning in 2019. The Centers for Medicare and Medicaid Services (CMS) declared 2017 a transition year, with advancing care information contributing 25% of the performance score, quality contributing 60%, and improvement activities 15%. For 2018, the quality category weight decreased to 50% and the cost category increase from 0% to 10%. In 2019, quality will decrease again to 45%, with the cost category increasing to 15%. In 2020, quality is proposed to drop again to 40%, with further proposed decreases to 35% in 2021, and 30% in 2022. Cost is proposed to rise to 20% in 2020.

Dr. Worthing will also provide an update about the Medicare Evaluation & Management (E/M) proposal that relates to Medicare reimbursement outside of MACRA adjustments.

“Last year’s proposal was to collapse codes, and that was expected to drop reimbursement 3%,” Dr. Worthing said. “That was changed, and the new proposal is expected to increase reimbursement by about 15% in 2021!”

Finally, Dr. Worthing will also discuss upcoming changes to MACRA proposed this summer, with expected final rulings due this fall.

Rheumatology APMs

Kwas Huston, MD
Kwas Huston, MD

The second speaker of the day will be Kwas Huston, MD, a Clinical Assistant Professor of Rheumatology at the University of Missouri-Kansas City School of Medicine, Kansas City, MO. Dr. Huston will provide an overview of alternative payment models (APMs) and progress being made toward a rheumatology-specific model.

Practices are enrolled in MIPS by default and can choose to enroll in an APM, but there are only a few APMs currently available, and none that are specific for rheumatology. ACR has been working to develop a rheumatology-specific APM.

“The draft has undergone multiple revisions and been approved by the ACR Board of Directors,” Dr. Huston said. “Our most recent work has been to develop proposed payment rates for different categories in the APM, which has been a somewhat challenging task.”

During his presentation, Dr. Huston will discuss the rheumatology APM, how it is different from what most practices do now, and why it might be better for physicians and patients.

For example, some of the things the rheumatology APM will address include increasing resources for cognitive services, providing resources for better education for patients, allowing more time for shared decision making, reaching out to patients between appointments, reducing charting requirements, and paying for high-value services like non-face-to-face communication.

“This is an opportunity to improve care for patients and improve function of rheumatology practices,” Dr. Huston said.

Taking Advantage of RISE

Janell Martin, CAE
Janell Martin, CAE

The final speaker of the session will be Janell Martin, CAE, the ACR director of registry operations, who will discuss the RISE Registry and its connection to MACRA legislation. RISE can help practitioners to navigate MACRA, specifically the MIPS pathway, because registry users can submit for all required domains: Quality, Promoting Interoperability, and Improvement Activities (cost score is calculated by CMS).

Among the important features of RISE are its ability to seamlessly report practice data under the quality category of MIPS, its minimal impact on provider workflow, and its interactive dashboard that gives access to provider and practice trend data to identify potential areas for improvement.

“MACRA is one example of a shift in health care away from a standard fee-for-service to adjusting payments for services based on the quality of care a provider offers,” Martin said. “A tool like RISE plays a fundamental role in not only meeting reporting requirements, but also in understanding and improving the quality of care being provided and, ultimately, improving the health and wellbeing of patients.”

During her presentation, Martin will go into detail about the RISE dashboard, how it functions, what it is intended to do, and how RISE can assist practices in identifying opportunities for quality improvement.