No More Wishful Thinking - MACRA/MIPS is Here to Stay

Do you remember three years ago when Andy Slavitt, former Acting Administrator of the Centers for Medicare and Medicaid Services (CMS) said, “The Meaningful Use program as it has existed, will now be effectively over and replaced with something better?” The truth was far beyond the wishful thinking of many providers and EHR vendors who had been struggling to keep up with the demands, technology and resources required to be compliant. If you were like many, you only “heard” the first part of that statement, “The Meaningful Use program as it has existed, will now be effectively over…” Oh yes, selective hearing at its best!

We now know what Slavitt was hinting at - CMS’s Meaningful Use program was being replaced with the Medicare Access & CHIP Reauthorization Act (MACRA). As an effort to minimize reporting, combine programs and reduce burden on providers, MACRA is a repackaged set of programs and requirements that aim to improve efficiency and patient outcomes, and promote interoperability between clinicians and healthcare vendors.  Yet providers are still struggling to understand the Quality Payment Program (QPP) and vendors are battling the uphill climb of implementing and adopting the technology required to obtain or maintain certification. 

If you had time to review the 2017 QPP Experience Report that CMS released earlier this year, you know that it provided a surprising overview of the clinician reporting and participation results of the 2017 Transition Year of the QPP.  We learned that 95% of the MIPS Eligible Clinicians participated in MIPS and 93% received a positive payment adjustment. 

Fantastic, right? But did you know that although the possible positive payment adjustment for 2017 was 4%, the highest payment adjustment received by top performers was a mere 1.88%?  How’s that to keep you motivated!  But let’s be honest, most clinicians easily avoided the negative 4% payment adjustment by submitting only 3 points; yes, only 3 points via the Test option of Pick-Your-Pace.   It was as easy as submitting just a couple of measures.  That might explain why only 5% clinicians received a negative payment adjustment.  Pick-Your-Pace is no longer in place and the performance threshold and payment adjustments increase year after year. 

The stark reality is that for 2018, clinicians had to submit at least 15 points in order to avoid the 5% negative payment adjustment. This year, clinicians must submit a minimum of 30 points to avoid a negative 7% payment adjustment and it continues to get harder.  For the 2020 reporting year, clinicians must submit 45 points to avoid a negative 9% payment adjustment. 

No matter how many times you repeat it during your soliloquies, MACRA is not going away—and wishful thinking won’t help either.  You can however, stay informed and educate yourself and your practice staff on MACRA. You can also better understand your eligibility- are you on the MIPS track, the APM track or both?  Ask yourself if your goal is to avoid a negative payment adjustment, or will you try to earn and submit as many points as possible to earn the maximum payment adjustment? 

Remember, you are not alone in this process. There are many resources available to you including the CMS and QPP websites.  At Kareo, we want you to be successful and have also created additional helpful resources that are just a click away and most are available right within your EHR!   

We provide ongoing training, one-on-one consulting via our Professional Services as well as various webinars throughout the year.  Our next MIPS/MACRA is only a week away! If you haven’t already, save your seat now for Simple Steps to Avoid the 7 Percent Negative Payment Adjustment by registering here.


About the Author

Marina is a Sr. Training Specialist guiding Kareo customers to higher levels of success with their CMS Incentive Program reporting, including MIPS and Meaningful Use...

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