Oculus Health and MACRA: Effortless Performance-Based Incentives



What is MACRA?

59% of physicians in the United States are not participating in MACRA (Medicare Access and CHIP Reauthorization Act), despite launching Chronic Care Management (CCM) program that is reimbursed by Medicare through CPC+.

CCM supports MACRA. MACRA combines the best of the Physicians Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one program called the Merit-based Incentive Payment System, or MIPS -- because Medicare can only communicate in a series of abbreviations.

MIPS, the incentive payment system under the Medicare Access and CHIP Reauthorization Act (MACRA), is based on performance in four categories:

  1. Quality of Care: 60% of the score in the first year.
  2. Resource Use: 0% of the score in the first year.
  3. Clinical Practice Improvement Activities: 15% of the score in the first year.
  4. Meaningful Use of an Electronic Health Record System: 25% of the score in the first year.

If this sounds familiar, it’s likely because your practice is already taking advantage of CPC+. If this doesn’t ring a bell, you’re not alone: 25% of physicians in the United States have never heard of MACRA. 

How Chronic Care Management (CCM) Supports MACRA: 

Medicare recognizes that Chronic Care Management (CCM) is arguably the most critical aspect of primary care. CCM reimburses physicians for “non-visit based care” such as creating a care plan and following up with poly-chronic patients. Poly-chronic patients are patients that could have lifestyle-related health issues such as diabetes and high blood pressure. More often than not, the term poly-chronic refers to the elderly (think Alzheimer's and cancer).

If these patients don’t receive consistent, quality care and cannot communicate effectively with their doctors, they are more likely to end up in an emergency room or back in the doctor’s office with a more serious condition. This puts a preventable strain on our health care system.

Chronic Care Management has been a burden for primary care practices that are already overwhelmed by their patient load, especially in rural communities. That said, CCM supports MACRA via CPC+: a payment model that gives primary care practices financial flexibility and reimbursements based on performance.

Based on the what MACRA entails (an incentive payment system based on performance), the primary care practices already leveraging the benefits of CPC+ would qualify for the payment model, and financial benefits, laid out by MACRA. MIPS and CPC+ merit-based incentives meet the same criteria.

Criteria for MACRA’S Performance-Based Incentive Payment System

  1. Quality of Care (60%)
  • Physicians report 6 measures, one which must be an outcome measure.
  • The Centers for Medicare & Medicaid (CMS) will use claims data to calculate the all-cause hospital readmissions measure for groups of 16 or more eligible clinicians who have at least 200 eligible cases.
  • All measures available under PQRS are available in MIPS.
  • To receive the highest score possible, physicians must report on 50% of patients that qualify for each measure chosen, regardless of payer, unless reporting via claims or the CMS Web Interface where only Medicare Part B patients are included. 
  1. Resource Use (0%)
  • No data submission is required in the first year.
  • CMS calculates cost using claims data.
  • Measures include Medicare spending per beneficiary (MSPB), total per capita costs, and condition and episode-based measures (predominantly based on inpatient codes).
  1. Clinical Practice Improvement Activities (15%)
  • Select from a list of 92 activities.
  • Physicians will report two high-weighted activities (worth 20 points each) or four medium-weighted activities (worth 10 points each), or a combination to achieve 40 points total.
  • Eligible clinicians in small practices (15 or fewer clinicians), rural practices, or health professional shortage areas (HPSA) can report one high-weighted activity or two medium-weighted activities (measures are double weighted).
  • Certified patient-centered medical homes (PCMH) will automatically receive full credit).
  1. Meaningful Use of an Electronic Health Record System (25%)
  • Advancing Care Information (ACI) is comprised of the base score (50%) and performance score (50%).
  • The base score requires a numerator/denominator or yes/no statement for each required measure.
  • Physicians must report all required measures to receive a base score. Failure to achieve a base score will result in a score of zero for the entire performance category.
  • Required measures vary depending on which version of certified EHR technology (CEHRT) utilized (2014 edition CEHRT or 2015 edition CEHRT).
  • Physicians can report additional measures to receive a higher performance score.
  • The performance score is based on actual performance rate for each measure reported (excludes security risk analysis and e-prescribing).
  1. Oh, and one more thing…

MIPS Reporting Options: You may report using different mechanisms between categories, but only one method of reporting can be used within each category.

  • Medicare Part B claims-based reporting
  • Qualified Registry
  • Certified electronic health record technology (CEHRT)
  • Qualified clinical data registry (QCDR)
  • CMS Web Interface (for groups of 25 or more eligible clinicians)

Easy, right? ...Are you still there?

We lost you somewhere between points 4 and 5? Not to worry: 47% of physicians in the United States do not know which payment track they should choose under MACRA or the basic ins-and-outs of the qualifying reporting requirements for MIPS. When reading through points 4 and 5 it’s challenging not to see the potential for new workflows to fail resulting in more valuable time and money wasted for primary care practices.

Oculus Health and MACRA: Effortless Performance-Based Incentives

Oculus Health works with primary care practices’ existing workflows to combine technology and decision support to produce scalable, high-touch care models that virtually eliminate manual processes. Fulfilling MACRA’s requirements is effortless with the applications ease of documentation and reporting, providing an improved patient-provider experience and tremendously reducing the cost of care. 

Track referrals and communicate with at-risk, poly-chronic patients electronically, in real time. The easy-to-use reports detail MIPS key performance indicators across Annual Wellness Visits, Chronic Care Management, Post Acute Care, and Transitional Care Management.

MACRA and Oculus Health work together to enhance primary care delivery and put quality, accessible health care in the hands of more patients in the United States. Learn more about what you can do to achieve excellence in healthcare at www.oculushealth.com.

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