MACRA/MIPS Reporting in 2017: What’s in Store for 2018?

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As physicians, doctors, healthcare units, ASCs, and medical billing and coding companies observe this year’s passage of newly laid MACRA/MIPS reporting rule, there is a lot of dilemma with regard to its positives and avoidance for the year 2018.

However, it will be important to notice whether the final rule continues to trend the value-based care. Also, given the intricacy and sweeping nature of QPP/MACRA, it is yet to be seen whether or not positives and avoidances will actually alleviate administrative burden.

Experts, including those working in the government, who are keenly observing the scenario, have some important takeaways from the proposed rule:

  1. Around 34%-36% of physicians will be eligible for MIPS after all exclusions, although they make up 55%-58% of Medicare Part B charges.

MACRA/QPP is an enormous piece of legislation. And at its business end, MACRA will eliminate the sustainable growth rate formula and replace it with a 0.5% annual rate increase throughout 2019, after which physicians will be or would be encouraged to shift to one of the two Quality Payment Programs:

1) Merit-Based Incentive Payment System (MIPS)

2) Alternative Payment Model (APM).

  1. The proposed scenario for 2018 rule includes the option for providers to band together in Virtual Groups.

If you remember, this option was not available in 2017. The situation with Virtual Groups is that it allows solo practitioners or physicians in groups of 10 or less to virtually combine for MIPS participation. To become a Virtual Group, a solo practitioner or group must combine with at least one more solo practitioner or group, regardless of location or specialty. Make sure you register before the 2018 performance year also solo physicians must be eligible for MIPS on their own.

  1. Hospital-based doctors can now report at a facility level as well

Hospital-based physicians in the year 2018 MIPS performance period will now have the opportunity to be evaluated on quality and cost, in context of the facilities where they practice. Such physicians can submit their facility’s in-patient value-based score to help calculate an individual score.

Experts are of the opinion that that such a move could be a big win for administrative simplification, as before, there was no recognition or special category for doctors who work in facilities such as a hospital.

  1. If everything goes well directed and streamlined, the CMS has proposed adding bonus points to the MIPS scoring methodology.

With talking about positives of the MIPS 2018 program, physicians have the opportunity to earn bonus points if they care for complex patients (i.e. up to three points), and are part of a practice with 15 or fewer physicians (i.e. up to five points), or exclusively use EHR Technology. The program also allows the use of 2014 edition, but CMS wants to push providers to use the 2015 edition through the use of bonus points.

  1. The weightage of the measures which contributes to the MIPS composite score will be adjusted.

For the 2018 performance year, the composite score will be weighted as follows:

  • Quality: 60 percent
  • Cost: 0 percent
  • Advancing Care Information: 25 percent
  • Improvement Activities: 15 percent

The proposed rule, the amount of time, the cost category is weighted at 0 percent to 2020. And from 2021, CMS would still ramp up the weight of the cost category to 30 percent as originally planned.

So, this makes it pretty clear for Physicians/Doctors and healthcare organizations including the medical billing and coding personnel to pay heed to the latest altercations of MACRA/MIPS.

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