Accountable Care

MACRA: Its Impacts, and What You Need to do Part II

Abhinav Shashank
Sat 12 November 2016

In the last version, we talked about the impacts of the MACRA, how it’ll affect your payments, your practice, and other major aspects. Since this law is going to change the entire health industry, what should be the most important on your checklist for MACRA?

Before you start going into the specifics of MACRA, you need first to find out whether you have more than $30,000 Medicare payments and more than equal to 100 Medicare patients. If this is the case, then you are qualified as MIPS Eligible Clinician. If in your practice, there are more than one Eligible Clinicians together then you need to decide whether you’ll report as an individual or as a group with others. Besides this, if your practice is in the category of small, rural, non-patient facing, or HSPAs then you’ll get assistance from Medicare. Check for this eligibility too.

Furthermore, you need to learn about the APMs, the eligibility criteria, how would MIPS and APMs affect the payments. Now that you know that you’re in MACRA, the first and foremost thing you need to do before MACRA implementation is to formulate a strategy around it, educate your team about MACRA, and encourage discussion on MACRA to spread awareness.

Have you checked your EHR? Under MACRA, an EHR should have Meaningful Use attestation. Find out whether your EHR is certified or not. Check the quality measures list and figure out which ones will you report on. If you can select a specialty measure set, plan the measures you will report on. Analyze your practice’s performance as per the previous requirements.

Learn more about the activities in CPIA and which ones you can easily inculcate in your practice. The reporting period for CPIA is 90 days, select the best period for you in 2017 to do the same. If you are a participant in an accredited Patient-centered medical home (PCMH), a medical home, a Medicaid medical home model, or if you have been recognized as a patient-centered specialty model, make sure that you have the current certifications and accreditations. All the physicians that participate in the above mentioned medical homes earn full CPIA credits.

If you had not been reporting before and in 2017 it’ll be your first time, then you just need to do minimal reporting and avoid the negative adjustments. For reporting, you can report through a third party qualified clinical data registry or group practice reporting option (GPRO) report on the measures required under MIPS. If you want to report in a group under GPRO, you’ll need to have a group of 25 or more Eligible Clinicians.

As for the APMs, you’ll have to confirm first whether you are qualified to be a participant in any of the Advanced APMs. If no, then talk to specialty societies or state medical society to learn more about the opportunities. Evaluate your practice and find out whether you’ll meet the threshold to qualify for the incentives for your significant participation in an advanced APM.

MACRA is a complex law and requires a lot of understanding; it is recommended that you gain firsthand knowledge of all the aspects of MACRA and get your practice ready for it accordingly.


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