MACRA: Not Just an Acronym Inside an Acronym Save

Education on MACRA is the key to successful survival. The important take home points noted in Dr. Will Harvey’s lecture at ACR 2016 (session title: Holy MACRA! How to Survive and Thrive in the New Era of MACRA, MIPS, and APMs) are stated below.

• MACRA stands for Medicare Access and CHIP (Children’s Health Insurance Program) Reauthorization Act of 2015
• It replaces the SGR (Sustainable Growth Rate) formula.
• Two new pathways will emerge: Merit Based Incentive Payment Systems (MIPs) which will be based on four metrics (quality, resource use, clinical practice improvement and advancing care information) and Alternative Payment Models (APMs) including medical homes, ACOs, and bundles.
• MACRA is broken down into two components – what happens from January 1, 2017 through January 1, 2019 and then from January 1, 2019 forward.
• Medicare rates will increase 0.5% each year from now through 2019, while shifting Medicare compensation from fee-for-service to pay-for-performance.
• You will need to begin attesting to either pathway in 2017 as this is the MIP performance period for 2019 incentive payments.
• MIP scoring will be out of 100 points and will be announced in November for the following year.
• 2017 MIP score is 3, but if you can score over 70 (high performance threshold) you may have access to more money in 2019

1. Quality – 60% of your score

Metrics for rheumatology include: advanced directives, BMI screening & f/u, comprehensive medication list, tobacco screening, HTN screening & f/u, sending consult note to referring physician, TB screening for biologics and yearly TB screening for biologics, RA disease activity, RA functional assessment, RA prognosis, and RA steroid management.

2. Resource Use – 0% of total in 2017-2019

ACR will be working with CMS to minimize the impact of Part B drug cost calculation issues.

3. Practice Improvement – 15% of your score

Over 90 different activities as listed on the ACR MACRA website

4. Advancing Care – aka meaningful use – 25% of your score

Required measures: EHR security risk analysis, E-Rx, patient access to electronic health records, send summary of care, and accept summaries of care for patients.

Optional measures: patient-specific educational information, ability for patient to view, download and transmit personal records, secure messaging, patient-generated health data, medication reconciliation, immunization registry reporting.

Bonus: additional public health reporting, report using certified HER, and participation in a registry such as the ACR RISE (Rheumatology Informatics System for Effectiveness) registry.

• Strategies for success include using a certified EMR, ensuring you are meeting PQRS measures and meaningful use, look at practice improvement measures and discussing with your practice manager, and join the RISE registry!

For more information continue to visit the ACR MACRAlerts website http://www.rheumatology.org/Practice-Quality/Administrative-Support/MACRA/MACRAlerts.