MACRA basic information and actions for 2017

MACRA is an acronym that describes how Medicare will be reimbursing physicians as of January 1^st, 2017. All Medicare Participating Providers are automatically affected as the measures under MACRA will affect how much they get paid for their services. MACRA is composed of four basic areas: Advancing Care Informatics/Innovation (25%) – Call it “Next Generation Meaningful Use” with a strong HIPAA Security component. In other words, failure to conduct a Security Risk Assessment with the corresponding Security Management Plan and HIPAA Security actions will nullify any potential points you may qualify for under this area. In addition to the Security Attestation with its subsequent actions there are other steps to cover including sending data to immunization registries and a basic number of objectives.

• Only 6 objectives (pass/fail)
• Immunization registry reporting required
• Reporting to more than one public health registry earns bonus point
• Failure to attest to “protecting patient health information” results in zero total score
• Security Attestation Required

Quality Reporting (60%) – PQRS replacement. Must report on at least 6 measures. Additional points may be reported via the Electronic Health Records (EHR) and Providers must select the reporting measure and enter the same as data in their electronic health record.

• Need 6 reporting measures out of 200 possible
• Include one cost cutting measure and one outcome measure
• Up to 4 bonus points may be accessed if outcome is captured and documented in a certified electronic health record.

Clinical Practice Improvement Activities (15%). Requires attestation of four improvement activities for a period of 90 days.

• 90 day reporting period
• 4 different categories with over 90 activities to choose from
• Activities points vary
• Must select enough activities to get to 60 points

Value Based Modifier. No data submission required. Calculated from claims.

• Quality of care furnished compared to the cost of care during a performance period
• Developed for hospital-level measurement
• 41 episode-specific measures potentially added
• CMS will calculate three additional measures.  Data for these will come from claims submitted.
• If there is not enough volume CMS will adjust value to other categories to compensate.

Based on the above the recommended plan of action will be:

1. Conduct a HIPAA Security Risk Assessment before Dec 31^st. Baseline Price for this effort if conducted by Taino Consultants Inc. is $2,000.
2. Prepare for Meaningful Use submission in January 2017.
3. Prepare and capture attestation measures for Clinical Practice Improvement Activities.

There may be additional steps needed to set-up the Practice so most measures are automatically send but this will require additional information and potentially a visit to ensure all specifics are covered. These actions may be looked at later as some of them may not be needed until later in the year.