MACRA and MIPS- Thoughts?

[Weirdy]

Any thoughts amongst us pre-pods?
Link where I got the info: http://www.nrhi.org/work/what-is-macra/what-is-macra/

Under MACRA, care providers paid on 2 systems:

-MIPS: Eligible professions (EPs) measured and paid based on the following:

1. Quality;
2. Resource Use;
3. Clinical Practice Improvement; and
4. Meaningful Use of Certified EHR Technology

Based on the MIPS composite performance score, providers will receive positive, negative or neutral adjustments to the base rate of their Medicare Part B Payment that will increase each year from 2019 (+4% to -4%) through 2022 (+9% to -9%), when adjustment levels will stabilize. The MIPS composite performance score will be determined by performance measures established in the forthcoming MACRA rules.​

-APM: Alternative payment models, provide a new way for Medicare to compensate healthcare providers for the care they give to Medicare beneficiaries. Most providers who participate in APMs will also be subject to MIPS, but will receive favorable scoring – with correspondingly higher reimbursement rates.

Site does a bad job of describing what APM will actually encompass.

What I've seen from the Residents/Physicians Pod Thread:
- private practices with <25 personnel are going under due to overhead/certifications to keep their facilities open/red tape
- Bigger shift/competition for hospital/multi-specialty slots
- Shift towards quality based and away from bill-per-procedure

Problems I personally see:
- EHR certified....you don't use their stuff, you aren't eligible. $$$
- Value based care is nice and all on paper, but how many patients are going to follow through, give accurate descriptions of what they've been doing, and keep to the treatment plan? EPs (eligible physicians) assume higher risk. You're at the mercy of what your patients do and report.
- MACRA not going away anytime soon. They're aggressively pushing for higher percentages of "value based" performance every 3 years (+/- 4% 2019 to +/- 9% by 2022).
- Its happening across the board. I go to a university where our research involves coordination with cardiology patients. Even specialties within MD/DO realm are getting hit with "quality based" performance measures. The percentages are increasing per reimbursement/payment and they're projected to be huge, up to 30-45%.

EDIT: special thanks to the docs and students slugging it out over in the other thread for the exposure.

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[theconzumer]

I'm not very knowledgeable about MACRA and MIPS but I know physicians fear that if it successful, insurance companies will likely follow this model.

 

[bobtheweazel]

This should at least be better than the patchwork attempts of rewarding/penalizing based on quality that they've been using up to now. And sure it sucks, but it's really not toooo horrible and they do take a lot of things into consideration when making these policies. Like I believe for the PQRS tracking you had a range of data sets that you could track and you would choose what you track, whatever would be easier given your specific practice. So they're giving us options, sounds like a pretty not-so-horrible thing to do. Also PQRS was rolled out in stages and some tracking requirements changed over time to streamline things. For instance, in the other thread it was said that you had to make 50% of your patients log into the patient portal. Like your staff could coach these little old people on how to log into the fancy computer machine but the patient had to physically do it themselves. Yes, that would be annoying. Buy eventually the requirement went down and the most recent I've heard was that the requirement was only one patient per year has to log in to their portal. Taking into consideration that the requirement was a little absurd, they stepped it down...also sounds like a pretty not-so-horrible thing to do. Some government/insurance requirements seem stupid but they usually have good intentions behind them. Not everybody is out to get us. And anyway this stuff affects all of medicine, not just podiatry. There is backlash and resistance to change from all medicine, not just podiatry. But too many docs have profited on the past fee based systems that rewarded doctors for just doing as many procedures as possible. The future is in quality care where the guy who does 2 or 3 times as many procedures won't necessarily be paid more than the guy who does fewer procedures but gets better results. That's the way things are going, like it or not. Sure, we'll have to fight to keep things within reason, but we can at least find solace in the fact that we won't have to fight alone, as this affects pretty much all DPMs/MDs/DOs.

Edit: Access to the EHR through the portal has to be given to at least 50% of the Medicare patients, but only one single patient has to actually access/use it.

https://www.cms.gov/Regulations-and.../EHRIncentivePrograms/Downloads/Stage3_EP.pdf


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[HappyHobPod]

Like your staff could coach these little old people on how to log into the fancy computer machine but the patient had to physically do it themselves.

only one single patient has to actually access/use it.

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