A Quick Guide to Understanding MACRA
In the past decade, reimbursement has been closely tied to the quality of care. Although healthcare has always centered around the patient, new incentives are ensuring that patient satisfaction is driving the industry. This has caused many physicians to rethink their daily operations and workflow.
The Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) scores were the first regulations implemented that involved patient experience. HCAHPS surveys ultimately determined the benefits received by the Centers for Medicaid and Medicare (CMS). Low-scoring hospitals were penalized and found they needed to enhance patient outreach to receive positive outcomes. MACRA is now the next step in converting the industry to a patient-centric focus.
What is MACRA?
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is legislation signed on April 16, 2015. It switches the current system with a program that pays through performance. The act repeals the Sustainable Growth Rate formula and replaces it with the Quality Payment Program (QPP). It enacts a new framework for payment that focuses on quality, accountability, and value.
MACRA rewards clinicians for value rather than volume. It compensates physicians for giving better care over more service. It simply makes sense for everyone. Clinicians will not only see an increase in revenue, but patients will see an increase in the quality of care.
The Value-based Payment Modifier (VBM), Physician Quality Reporting System (PQRS), and the Medicare Electronic Health Record (EHR) incentive program are all rolled into one payment process under MACRA. That program is called the Merit-based Incentive Payment System, or “MIPS”.
The Merit-based Incentive Payment System (MIPS) is made to simplify things. The program will determine Medicare adjustments using a composite performance score of eligible professionals (EP). This will determine whether an EP will receive a bonus, a penalty, or no payment adjustment at all. The score is based on 4 categories with different levels of importance:
- 50% for quality (PQRS/VBM)
- 25% for Meaningful Use (specifically resources)
- 15% for clinical practice improvement activities
- 10% for resource use (specifically certified electronic health records (EHR) technology)
Over time, these percentages will shift to place an increasing focus on the use of resources. The “MIPS score” runs from 0-100 and can significantly impact a provider’s payment year. The best way to get ready for the MACRA and MIPS changes is to work on satisfying Meaningful Use Stage 2 requirements, continue to work on PQRS requirements, and begin implementing a plan focused on patient engagement.
Patient Engagement Strategy
If you want to engage patients, you need to connect with them in a way that creates value. Modern healthcare consumers are best reached via digital channels, yet most would be pleasantly surprised if you did. There’s a disconnect there. Patient engagement tools like CarePassport bridge that gap.
CarePassport is a patient-centric healthcare app with mobile capabilities. It simplifies your practice workflow while improving patient communication. MACRA is based on scoring and when you provide a mobile portal for your patients, there’s less opportunity for a bad score based on engagement. CarePassport can also benefit a healthcare provider through:
- Patient scheduling and sending push notifications.
- Advanced appointment check-in, complete with e-signature.
- Pre-registration and Pre-authorization of insurance.
- Secure messaging and direct patient communication.
- Patient ability to receive and view all MRs, including images.
- Opportunity to educate the patient, including discharge summary.
- Medication management, including reminders and follow up.
Additionally, CarePassport incorporates a tool that can help you measure patient satisfaction using your own customized surveys. You can analyze patient data and spot trending before it affects your bottom line.
The intent of MACRA is good and proactive clinicians have nothing to fear. The program is meant to recognize a job well done. With the proper planning, resources, and smart tools in place, engaging your patients will increase efficiency, drive revenue, and make people happier and healthier.