MIPS/MACRA Basics for Eye Care Practices

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Does your consumption of mood-altering beverages increase right around the time CMS issues its final rules? If so, you’re not alone.

If you’ve ever owned an iPhone, you’ll know that the quasi-yearly product launches can be underwhelming. Despite the predictable hype, the latest model sometimes seems a lot like the old one, with a facelift. So back in April, when CMS Acting Administrator Andy Slavitt gave a nod to Apple by introducing MACRA as the “biggest product launch of the year,” it was no wonder physicians were collectively giving him the side-eye.

 Besides the arduous task of quantifying quality, MIPS/MACRA aims to ease physicians’ reporting burdens

MACRA, aka the “doc fix” bill, makes big promises. Besides the arduous task of quantifying quality, MIPS/MACRA aims to ease physicians’ reporting burdens. Is this not-yet-final rule up to the challenge? CMS is still working on the details, taking into account the thousands of comments they’ve received (comments closed on June 27) before issuing the final rule this fall. So what’s the best way for forward-thinking ECPs to prepare? Keep reading to get the jump on MACRA, whatever it turns out to be.

Alphabet Soup

Every CMS rule is peppered with letters—literally. Brand new acronyms, new acronyms for old terms, and old acronyms that most of us never quite got the gist of. Below, a quick-start guide:

ACI (Advancing Care Information): One of the four MIPS categories—the one that’s replacing Meaningful Use (more on that later).

APM (Alternative Payment Model): Payment models other than fee-for-service, like accountable care organizations (ACO), bundled payment arrangements, and patient centered medical homes (PCMH).

CPIA (Clinical Practice Improvement Activities): The new 4th performance category of MIPS.

EC (Eligible Clinician): The term CMS chose to replace the EP you’re probably used to. It encompasses the broader range of health care professionals eligible to participate in the QPP.

MACRA (Medicare Access and CHIP Reauthorization Act of 2015): The law intended to steer our healthcare system towards CMS’ three goals of better care, smarter spending, and healthier people by focusing on incentives, care delivery, and information sharing.

MIPS (Merit-Based Incentive Payment System): Part of the QPP, MIPS streamlines the current Meaningful Use, PQRS, and the Value-based Modifier (VBM) programs, combining them and adding a new 4th category (CPIA).

QP (Qualifying Participant): An EC who is eligible to participate in the QPP’s APM track. MACRA offers additional rewards for participation in APMs, and even higher bonuses for advanced APMs.

QPP (Quality Payment Program): The pay-for-value system that MACRA created, consisting of two tracks: MIPS and APM.

Photo Credit: Gaby Av CC BY 2.0

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