Rad Oncs and MACRA - pick your poison

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Gfunk6

And to think . . . I hesitated
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Relevant background: https://www.astro.org/MACRA/

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) calls for alternative payment models for all Medicare patients effective January 1, 2017. Recent provisions have exempted MDs who see little/no Medicare patients (e.g. cosmetics, concierge medicine). There are two paths that physicians may choose:

1. The Merit-Based Incentive Payment System (MIPS) - continued fee-for-service but with enhanced quality measures
2. An Alternative Payment Model (APM) - higher risk:reward ratio. Practice takes nominal risk, keeps the money over what it costs to implement care; eats costs if they go over.

Our practice's Med Oncs participate in the Oncology Care Model (OCM) so are exempt from MACRA. However we still have Rad Oncs, Surgeons, and PCPS. For Rad Onc, it doesn't appear that APM is mature enough to participate (outside of a few forward-thinking markets) so we will probably head down the MIPS road.

How about the rest of you?

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We're starting to look into this now.

One thing I haven't found in my quick reading is exactly what quality measures for our field will be used in the MIPS? There is ASTRO commentary on this (https://www.astro.org/uploadedFiles..._Happening_In_Washington/ASTROMDPComments.pdf) which touches on the fact that these quality measures have little (if any) clinical significant for radiation, so why would they be important for a radiation-specific MIPS?

I believe the hospital system I work in (though not employed) is pushing for the MIPS, so we'll be following suit I suppose as well.
 
I was able to self educate a bit more. It appears we'll be doing the MIPS.

One big push from our administrators is to consider opening up mosaic into a patient portal access system. Anyone else do this yet? I know lots of PCPs and hospitals have a patient portal to check your labs, etc.
 
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Thanks - that's the best literature I've seen on this topic.

Don't love the quality measure of no bone scan for low risk prostate cancer, as 99% of the time if it is done it's ordered by a urologist, not a rad onc in my experience. So if you're using that metric, then you could possibly get "dinged" on that.

It's OK, they'll RP everyone anyways who is low-risk or put them on observation/AS if they have co-morbidities so you won't see them until it's time for salvage.
 
I am curious how smaller private practices are implementing this MIPS? It seems like a burdensome regulatory load for 1-2 physician groups.
 
I am curious how smaller private practices are implementing this MIPS? It seems like a burdensome regulatory load for 1-2 physician groups.

There are small practice exemptions, but I"m not sure how to quality for those...

We are a 5.5 physician group and we hired a consulting/billing firm to help us. A pain in the rear overall but they have been helpful so far. Basically, we were already doing most of these things, but tracking it/reporting it seamlessly/electronically can be cumbersome. With a combination of nursing intake (electronically entering pain score, etc) and EMR and reminder on dictations, we are electronically capturing things like pain score, making sure dose constraints are in treatment planning note, smoking cessation counseling, checking blood pressures for hypertensive patients, etc...We've also opened up some parts of Mosaic for patient portal access.

Some oddities are like when you document/bill a cpt 77470 (special treatment procedure, often billed for things like HDR brachy or concurrent chemo), you must document a pain score and pain plan on that same day of service because on the date that cpt code is billed goes in your denominator for patient "encounters" where pain should have been addressed.
 
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