A Helping Hand With MACRA

By David White

Right now, you are probably thinking that you do not want to hear another thing about MACRA (the Medicare Access & CHIP Reauthorization Act) either until the details are final or until there are some helpful steps you can take.  The details will be final very soon – before November 1 – and there are steps to take now.  As most of you know, MACRA replaced the old Sustainable Growth Rate (SGR) reimbursement formula with the Quality Payment Program (QPP) and the new reimbursement formula is going to focus heavily on quality of care.  While the payment adjustments do not begin until 2019, the reporting period begins January 1, 2017, so let’s get started with three facts to help you prepare.

First, ASN has been working to shape MACRA for quite some time now.  Most of those efforts involved providing input to Congress as it wrote the law, and then providing direction and input to the Centers for Medicare and Medicaid Services (CMS) as they drafted specific directions to implement the law – a process called rulemaking.  Now, ASN will provide nephrologists access to as much useful information as possible to help you navigate the new system. 

As MACRA is announced and implementation begins, ASN will use every tool of communication available to convey useful information and/or to guide you to useful resources.  To begin, the society has gathered resources created by ASN, CMS and peer societies that are available on the ASN website – please remember that these materials will be updated and added to as we get more details following release of the final rule. 

While you will have to choose to participate in one of the two tracks in the MACRA QPP – the Merit-Based Incentive Payment System (MIPS), or an Advanced Alternative Payment Model – the majority of physicians and practices will likely participate in MIPS.  Under MIPS, payments will be based on a formula that includes quality, resource use, clinical practice improvement activities, and ”advancing care information” (which looks at electronic health record use).  

Second, CMS is offering three reporting options for participation in MIPS beginning January 1, 2017.  By picking the participation pathway that is best for you and your practice, you can avoid a negative payment adjustment in 2019.  CMS will share more detail about these three options in the coming weeks.

Option One: Test the Program

Submit some data to the Quality Payment Program, including data from after January 1, 2017, and avoid a negative payment adjustment. This option is designed to ensure that the system is working and that physicians are prepared for broader participation in the coming years.

Option Two: Partial-Year Reporting

Report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after January 1, 2017 and your practice could still qualify for an incentive payment.

Option Three: Full-Year Reporting

Report Quality Payment Program information for the full calendar year beginning January 1, 2017 if you are ready and you might qualify for a modest positive payment.

Third, CMS has created the Transforming Clinical Practice Initiative (TCPi).  TCPi is designed to provide clinicians with the knowledge, tools and resources needed to achieve the goals that MACRA will reward – for small to large practices and the services provided are completely free.  You participate in the initiative by joining one of 29 grant-funded Practice Transformation Networks (PTN).  These are generally regional peer-based networks comprised of a broad community of practices all engaged in the work of medical practice transformation. 

Practices that join a PTN receive free support in the form of practice transformation coaches, online tools and resources, online and in person training, and other services to help them transition and prepare to be successful in MACRA whether they participate in MIPS or in APMs. 

The key outcomes of PTN participation could include:

Developing core competencies in practice transformation AT NO COST

Improving health outcomes and better coordination of care for patients

Developing robust and meaningful data collection and reporting systems

Closer alignment with new federal policies and incentives

Free CME credit and MOC points

Getting started:

To find an appropriate PTN, you have several options.  You can contact one of the 10 Support and Alignment Networks (SANs) that were also funded under the grant.  The SANs help connect you to a practice network in your area.  One such support network is the American College of Physicians and their support network is open free to all ASN members—including those who are not members of ACP.  To get started with that process, email them at SAN@acponline

Also, you may go to http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx to find a PTN in your area on your own.  But go soon, they are filling up fast

Besides these valuable outcomes, perhaps one of the most valuable aspects of participating in TCPi is that you will have access to expertise that may help you successfully navigate the transition to the new payment system.  

 


Additional information on MACRA here.

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Right now, you are probably thinking that you do not want to hear another thing about MACRA (the Medicare Access & CHIP Reauthorization Act) either until the details are final or until there are some helpful steps you can take.  The details will be final very soon – before November 1 – and there are steps to take now.  As most of you know, MACRA replaced the old Sustainable Growth Rate (SGR) reimbursement formula with the Quality Payment Program (QPP) and the new reimbursement formula is going to focus heavily on quality of care.  While the payment adjustments do not begin until 2019, the reporting period begins January 1, 2017, so let’s get started with three facts to help you prepare.

First, ASN has been working to shape MACRA for quite some time now.  Most of those efforts involved providing input to Congress as it wrote the law, and then providing direction and input to the Centers for Medicare and Medicaid Services (CMS) as they drafted specific directions to implement the law – a process called rulemaking.  Now, ASN will provide nephrologists access to as much useful information as possible to help you navigate the new system. 

As MACRA is announced and implementation begins, ASN will use every tool of communication available to convey useful information and/or to guide you to useful resources.  To begin, the society has gathered resources created by ASN, CMS and peer societies that are available on the ASN website – please remember that these materials will be updated and added to as we get more details following release of the final rule. 

While you will have to choose to participate in one of the two tracks in the MACRA QPP – the Merit-Based Incentive Payment System (MIPS), or an Advanced Alternative Payment Model – the majority of physicians and practices will likely participate in MIPS.  Under MIPS, payments will be based on a formula that includes quality, resource use, clinical practice improvement activities, and ”advancing care information” (which looks at electronic health record use).  

Second, CMS is offering three reporting options for participation in MIPS beginning January 1, 2017.  By picking the participation pathway that is best for you and your practice, you can avoid a negative payment adjustment in 2019.  CMS will share more detail about these three options in the coming weeks.

Option One: Test the Program

Submit some data to the Quality Payment Program, including data from after January 1, 2017, and avoid a negative payment adjustment. This option is designed to ensure that the system is working and that physicians are prepared for broader participation in the coming years.

Option Two: Partial-Year Reporting

Report Quality Payment Program information for a reduced number of days. Your first performance period could begin well after January 1, 2017 and your practice could still qualify for an incentive payment.

Option Three: Full-Year Reporting

Report Quality Payment Program information for the full calendar year beginning January 1, 2017 if you are ready and you might qualify for a modest positive payment.

Third, CMS has created the Transforming Clinical Practice Initiative (TCPi).  TCPi is designed to provide clinicians with the knowledge, tools and resources needed to achieve the goals that MACRA will reward – for small to large practices and the services provided are completely free.  You participate in the initiative by joining one of 29 grant-funded Practice Transformation Networks (PTN).  These are generally regional peer-based networks comprised of a broad community of practices all engaged in the work of medical practice transformation. 

Practices that join a PTN receive free support in the form of practice transformation coaches, online tools and resources, online and in person training, and other services to help them transition and prepare to be successful in MACRA whether they participate in MIPS or in APMs. 

The key outcomes of PTN participation could include:

Developing core competencies in practice transformation AT NO COST

Improving health outcomes and better coordination of care for patients

Developing robust and meaningful data collection and reporting systems

Closer alignment with new federal policies and incentives

Free CME credit and MOC points

Getting started:

To find an appropriate PTN, you have several options.  You can contact one of the 10 Support and Alignment Networks (SANs) that were also funded under the grant.  The SANs help connect you to a practice network in your area.  One such support network is the American College of Physicians and their support network is open free to all ASN members—including those who are not members of ACP.  To get started with that process, email them at SAN@acponline

Also, you may go to http://www.healthcarecommunities.org/CommunityNews/TCPI.aspx to find a PTN in your area on your own.  But go soon, they are filling up fast

Besides these valuable outcomes, perhaps one of the most valuable aspects of participating in TCPi is that you will have access to expertise that may help you successfully navigate the transition to the new payment system.  

 


Additional information on MACRA here.