As MACRA has evolved from volume based payment to value based payment, there has always been concerned about how this new model will require providers to provide information on the quality of service being given them, accountability that provider has to the treatment being performed/given and how valuable it is to the patients. MACRA comes with three parts – Physician Quality Reporting System (PQRS), Value Based System (VBM), and Electronic Health Record (EHR).

MACRA has created a quality program that repeals the sustainable growth formula. It has changed the way Medicare provides incentives based on value and not on volume. It streamlines the multiple quality payment programs under the new Merit Based Incentive Payments System, and gives bonus payments for participation.

Still the providers are burdened to improve outcomes for patients and to manage ‘value’ in care. There is lack of financial and limited technical support for further development, improvement, updating and expanding measures to use in the Quality Program. Patient-report outcomes and functional status measures also require attention.

How is CMS trying to make it easy for the providers?

The centers of Medicare and Medicaid services proposed a new rule intended for benefitting the telehealth and interoperability. Telehealth is a tool that is increasingly effective in enhancing the patient experience (consultations, remote patient monitoring, and patient self-management) which benefits both providers and patients. Therefore, CMS plans to have increment in access to Medicare telehealth services in rural and under-developed areas. This is achieved by having more consultants and making it easy for the providers to bill.

This MACRA rule is going to enable more usage for remote patient monitoring tools and encourage providers to be more attentive towards patient-generated health data. MIPS is encouraging use of digital technologies that provide either one-way or two-way data between eligible providers and patients. It indirectly also promotes patient self-management, remote monitoring, and detecting early indicators of treatment with no positive outcome.

As many changes take in effect this year, providers need to take quick initiatives so as to avoid penalties and optimize the payment incentives. It is difficult to decide which path to take as the task is to comply with new MIPS reporting requirements that are more complex. It requires proper use of technology, data and analytics.

Can outsourcing MACRA/MIPS be beneficial?

To overcome these challenges, the providers to use Patient Access to health information and educational resources as well as incorporate PGHD which includes standardized data capture and patient-generated health data. Along with this, there is a need to show improvement in patient experience measures, care coordination measures and measures of appropriate use of services. Outsourcing MACRA as a service offers an alternative for achieving MACRA objectives and driving continuous performance improvement year after year. The benefits of outsourcing MACRA/MIPS to iPatientCare are:

• The expert here enables the provider to gain access to MACRA/MIPS domain expertise in form of advisory services that can implement and establish the foundation for continuous performance at much faster rate.
• Provides flexibility to bring in precise resources needed for your practice, complementing the existing capabilities.
• It helps to extract and aggregate medical data for the electronic health records, calculating quality measures and comparing performance. This data collection process, eliminates the burden and cost of laborious and intensive manual process.
• Provide analytic services – that analysis the providers’ performance and hoe it will impact their reimbursements. The experts also identify the measures to improve performance.
• Consulting services – provides guidelines to improve measure scores and provides advice on enhancing the workflow. Also provides different scenarios to balance cost/benefit of specific changes to the measures.

Under CMS, it is more feasible for the providers as the final rule of quality payment program also adds a series of new billing codes that reimburse the virtual visits for risk assessments and care planning; once again making it easy to bill for the providers. It is best to leave the expertise and insight of those on the front lines so as to build truly a value-based healthcare system.

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