MACRA, MACRA, MACRA
Medicare Access and CHIP Re-Authorization Act of 2015 (MACRA) is paving the road towards a value-based payment model that’s set to replace the outdated fee-for-service (FFS) model. Merit-Based Incentive Payment System (MIPS) pulls together aspects from Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Payment Modifier (VBPM).
As of January 1, 2017, MIPS will become the new program from Centers for Medicare and Medicaid Services (CMS) that issues providers both financial incentives and penalties based on performance. In this article, we are going to take a deeper look into this scoring system, and specifically at the Clinical Practice Improvement Activities (CPIA), and how telemedicine can be used to meet these requirements (according to the current proposed guidelines, as the official rule will not be issued until November of 2016).
What is MIPS?
Starting in January of 2017, Medicare Part B eligible providers (EPs) will be evaluated on an annual basis in the following four categories (each with an assignment number of points), in order to derive a MIPS performance composite score:
• 10 percent (average of attributable measures) — Resource use
• 15 percent (60 possible points) — Clinical practice improvement
• 25 percent (100 possible points) — MU of certified EHR technology
• 50 percent (80–90 possible points) — Quality (VBMP/PQRS)
Because a physician’s points will be made public on the CMS Physician Compare website — it’s vital providers work hard to score the highest points possible. Let’s take a deeper look specifically at the CPIA requirements.
Clinical Practice Improvement Activities (CPIA) and You
In order for a practice to get the full 15 percent credit, they must amass the 60 points for CPIA. Activities will be updated annually. Currently, there are 90 in the proposed rule. Important points to consider regarding CPIA requirements are:
• Activities are weighted. Medium activities receive 10 points and high activities receive 20 points.
• Expanded practice access, that can include telemedicine and remote patient monitoring, offer the highest point values.
• Full credit is given if the provider participates in patient-centered medical home.
• An activity must be performed for at least 90 days in a performance period.
• Providers must report yes/no whether or not they meet the specific requirements.
How Telemedicine can assist with CPIA Requirements
Telehealth and remote patient monitoring will be key components used to meet the requirements set forth by MIPS CPIA, in the following three areas:
1. Expanded Practice Access
• 24/7 access to MIPS physicians or care teams for those in need of urgent or emergent care is a high-weighted activity according to the CPIA proposed guidelines.
• MIPS eligible physicians need to use alternatives to provide this access, which can include phone visits and remote patient monitoring.
• Patient follow-up can occur telephonically to improve quality of care and encourage follow-up treatment.
• Improvement in patient communication can involve more phone visits with physicians to meet these standards without requiring the patient to visit the office.
2. Population Management
MIPS eligible physicians that prescribe patients anti-coagulation therapy with warfarin must attest in the first year that 60 percent of their ambulatory patients on this therapy are being managed by clinical practice improvement activities. This management can include the use of telehealth and remote patient monitoring that coordinate systematic INR tracking, patient education, follow-up, and communication regarding dosing and testing.
Proactively manage patients whom are active with a provider which can include phone calls to provide patient education and remind patients of services due.
3. Care Coordination
Implement effective practices for care transition that include thorough documentation of how a MIPS eligible physician carried out a patient-centered care plan for the first 30-days following discharge. Telemedicine and remote patient monitoring can be used to communicate with the patient and anticipate needs to help prevent readmissions.
Where are you in your preparation for MACRA MIPS?
