I love the game of Scrabble. All those wooden letter tiles scattered across the board and your opponent reaching into the far depths of seventh grade vocabulary class (or Latin class, if you can get away with it) to score the triple word score.Yet when it comes to challenging words, no one throws them out better than Medicare and the Healthcare Industry, thus why acronyms are king, even if they aren’t allowed in Scrabble. For a medical practice owner or office manager, the use of acronyms can be maddening, just when you have a list memorized; they throw a few new ones in at fire speed, just like my grandmother on a hot Friday Scrabble night. Yet, most recently is was Medicare and Medicaid Services that were responsible for the best acronym of all time, MACRA, that can make your practice a winner or leave you wishing you had just agreed to play Bingo instead.
Give Me an “M” for MACRA
MACRA or the Medicare Access & CHIP Reauthorization Act of 2015 was introduced on March 24, 2015:
“To amend title XVIII of the Social Security Act to repeal the Medicare sustainable growth rate and strengthen Medicare access by improving physician payments and making other improvements, to reauthorize the Children’s Health Insurance Program, and for other purposes.” according to the H.R.2 – Medicare Access and CHIP Reauthorization Act of 2015, 114th Congress (2015-2016).
Through the induction of MACRA, there have been three significant payment changes for healthcare providers aiding Medicare patients.
These three points are what make up Medicare’s QPP (Quality Payment Program):
- MACRA ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.
- MACRA builds a better structure for incentives that rewards physicians and healthcare systems for giving better care not just more frequent care.
- MACRA combines the current existing quality reporting programs to make one new system.
MIPS and APMs, the Big Win Tiles
With the new MACRA QPP, there are two roads to efficient rewards for physicians and medical practices that care for Medicare Beneficiaries. These pathways are MIPS (the Merit-Based Incentive Payment System) and APMs (Alternative Payment Models). Both of these models are to take effect from 2015 to 2021 (and possibly further out).
Merit-Based Incentive Payment System
MIPS combines portions of the PQRS (Physician Quality Reporting System), the VM (the Value Modifier or Value-based Payment Modifier) and the Medicare’s EHR (Electronic Health Record) incentive program into one single program in which Eligible Professionals (EPs) will be measured.
MIPS Measuring Points:
- Quality-1-10 point measures assigned to each instance. Bonuses for Reporting (Patient Experiences/Satisfaction, Safety Measures, Appropriate Use and EHR).Scoring Measures for each category and 0 points for Instances not reported.
- Resource Use-Comparison of resources used across similar care treatments, condition groups and practices.
- Clinical Practice Improvement-An identified process for healthcare providers to identify, review, address and resolve failures in patient care.
- Meaningful Use of Certified EHR Technology-Certified EHR technology provides patients the assurance that the medical care facility’s technology meets all Medicare Meaningful Use parameters and offers acceptable security requirements.
Alternative Payment Models
APMs offer new guidelines for the payment of Medicare Beneficiaries’ health care providers. Some participating health care providers will receive a lump-sum incentive payment beginning 2019. There will be required more transparency in healthcare provider payment models. Starting in 2026, some health care providers will receive higher annual payments.
MACRA for the Win!
As with Scrabble the points can add up quickly for medical practices who are equipped to play the acronym game of Medicare’s MACRA efficiently. Winning the game can mean better patient care, increased medical practice revenue and efficient healthcare office management. Yet, for those who are not scrabble gurus, MACRA can be a perceived bunch of letters leading to more confusion.
If your practice is seeking to embrace MACRA and improve its profitability or simply seeks to adjust to the changes that will be required to operate in Medicare’s game of Scrabble, Southern Medical Consultants Group can help you find the sweet triple word score leading to a win!
For more information on Southern Medical Consultants Group visit us at: http://www.medicalconsultantsgroup.com/ or contact us at: (404) 272-4883.