The intricacies of meaningful use-MACRA-MIPS

Posted by Anna Brocato on March 15, 2018

The intricacies of meaningful use-MACRA-MIPS.jpg

Your electronic health record (EHR) is much more than just an upgrade over paper-based record keeping. It’s also integral to a more productive orthopaedics practice capable of earning payments (and avoiding penalties) from EHR incentive programs.

Current EHR incentives explained: MACRA and MIPS in a nutshell

These incentives come with complex requirements, which are frequently updated via legislation and rulemaking. The 2015 Medicare Access and CHIP Reauthorization Act (MACRA) is a prime example: 

  • MACRA consolidates multiple programs overseen by the Centers for Medicare and Medicaid Services (CMS), including the Medicare EHR Incentive Program for eligible professionals, into the Merit-based Incentive Payment Systems (MIPS).
  • MIPS incentivizes quality of care, as part of a broader shift away from the traditional fee-for-service (FFS) economics of healthcare to a more sustainable value-based reimbursement (VBR) model.

Despite the numerous regulatory changes, there is one constant across CMS incentive programs – the need to demonstrate efficient use of certified EHR systems in specific workflows. Advancing Care Information sets standards for evaluating your EHR.

This is easier said than done in many cases. In addition to the ongoing updates to legal requirements in MACRA/MIPS et al., there’s also misinformation and confusion about what orthopaedics must do to ensure they receive incentives and aren’t penalized.

Three Ways Changes to EHR incentives Could Trip Up Your Orthopaedic Practice

CMS has based all of its EHR-related programs on fundamental requirements, such as the ones governing e-prescribing and summaries of care. But MIPS introduced many changes to incentives structures, with one of the most significant being greater flexibility for providers in choosing the measures and activities most relevant to their practices. 

This adjustment as well as some of the unique modifications introduced exclusively for the MIPS transition period have pitfalls for orthopaedics looking to comply. Here are three to keep an eye on:

1) Determining what counts as a relevant MIPS measure

MIPS includes hundreds of quality measures. But just because a MIPS measure exists doesn’t mean it’s relevant to your practice, as everyone from psychiatrists to orthopaedists have discovered. Trying to meet all measures could result in unnecessary expenditures on extra equipment and software, which in turn produce irrelevant information that saps your productivity.

Instead of getting lost in the weeds, a better idea is to implement an orthopaedic-specific EHR such as Phoenix Ortho, with an all-in-one workflow that integrates a picture archiving and communications system (PACS) and practice management (PM). Additionally, Phoenix Ortho’s CMS specialists are able to provide the support orthopaedic practices need to ensure complete compliance. Such a solution gives you only the information you need to deliver quality care and adherence with MIPS.

2) Understanding the upcoming MIPS timeline

In 2016, CMS created MIPS pacing options to ease providers into the program. Different payment adjustments will be applied depending on when a practice starts reporting and how much data (e.g., a partial or full year) it supplies to CMS for MIPS purposes. Only a complete lack of submissions will result in a 4 percent penalty in 2017.

The upshot is that 2017 is sort of a red herring, at least in terms of what lies ahead for MIPS participants. In subsequent years, the maximum adjustments and penalties will both increase alongside the percentage of patients you will need to report on.

The only way to navigate these changes is with an EHR platform like Phoenix Ortho. It scales alongside your practice with an intuitive interface enabling streamlined collaboration and straightforward patient-facing data entry. Its adaptability leads to better treatments, outcomes and efficiencies.

3) Assuming additional risks in Medicare Part B

MIPS shifts risk from Medicare Part B to its providers. Ever since Medicare and Medicaid were enacted in 1965, the FFS model has dominated, but now a rapid shift to VBR is underway.

The stakes for a successful transition to MIPS are high. Quality of care will determine not only the payment adjustments you receive, but also how you are perceived on Physician Compare Initiative, which CMS maintains to help patients make informed choices. MIPS scores will eventually be published there.

As more orthopaedics participate in MIPS, they will need a comprehensive EHR capable of simplifying data management, improving patient operations and integrating multiple essential workflows, all toward the goal of providing better care. Phoenix Ortho’s EHR | PACS | PM empowers you to use clinical data analytics, perform rapid charting (via improved chart-by-impression) and ultimately treat and see more patients each day. 

Set up your free no-obligation online demo to learn more about how Phoenix Ortho empowers you to deliver a positive patient experience and earn greater MIPS incentives. 

why-choose-an-orthopaedic-ehr 

https://qpp.cms.gov/docs/QPP_ACI_Fact_Sheet.pdf

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MIPS-ACI-Deep-Dive-Webinar-Slides.pdf

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/2017ProgramRequirements.html

https://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/downloads/Beginners_Guide.pdf 

https://www.brookings.edu/blog/up-front/2016/12/15/key-takeaways-from-the-final-macra-rule-plus-remaining-challenges/

http://www.modernhealthcare.com/article/20160723/MAGAZINE/307239981

http://blog.healthmonix.com/minimum-mips-reporting

https://qpp.cms.gov/mips/quality-measures

https://www.psychiatry.org/psychiatrists/practice/quality-improvement/quality-measures-for-mips-quality-category

http://www.saignite.com/industry-expertise/quality-payment-program/mips-education/10-faqs-about-mips/

http://blog.healthmonix.com/pacing-for-macra-quality-payment-program

https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-Quality-Payment-Program-webinar-slides-10-26-16.pdf

https://www.facs.org/advocacy/federal/medicare/faq

https://www.cms.gov/medicare/quality-initiatives-patient-assessment-instruments/physician-compare-initiative/

 

Topics: Software, meaningful use, CMS, EHR, MIPS, MACRA, Orthopaedic EHR

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