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MACRA 101: We have the final rule for the QPP…now what?

MACRA, which stands for the Medicare Access and CHIP Reauthorization Act of 2015, was legislation that reformed the Medicare payment system to help lower the cost of health care, while delivering better quality and improving health outcomes. It represents a huge change – it creates a more comprehensive value-based framework for payment and combines different quality-based measures into one system.

In October, the Center for Medicare and Medicaid Services (CMS) issued the final rule for the new Quality Payment Program (QPP) following direction from the MACRA, and it goes into effect Jan. 1, 2017. As we get closer to this regulatory program, here are some key points to consider:

While 2017 is a transition year, Medicare Eligible Clinicians (ECs) must take action to avoid a penalty. CMS anticipates that more than 700,000 Medicare ECs will participate in the QPP.

ECs submitting any data in 2017 will avoid penalties, which is a lowered bar than was included in the original proposed rule. If an EC aims to earn an incentive, however, at least 90 days’ participation is required.

There are fewer overall measures in the QPP, but reporting will be more complex.

CMS will publish each physician’s performance in the QPP on Physician Compare, a website available to the general public.

The launch of the QPP merges the Meaningful Use program with others, including PQRS and the Value-based Modifier.  However, it is critical to understand that Eligible Providers (EPs) who were participating in Meaningful Use via the Medicaid path must continue to attest to that program even where they must also participate (at a minimum) in the MIPS-Advancing Care Information category to avoid Medicare penalties.

While Medicare EPs are largely familiar with using certified EHRs for Meaningful Use and PQRS, larger organizations often have substantial numbers of ECs – a population that, for the most part, will be brand new to this kind of EHR use and reporting.

3 ways smart providers are preparing for MACRA’s QPP

When faced with the most significant change to healthcare policy since the creation of Medicare and Medicaid, providers must take steps to succeed. Examples include:

1) Upgrade to 2015 Certified Electronic Health Record Technology (CEHRT) as soon as possible. This will enable new ECs to ramp up to new workflows without having to change EHRs in midstream. It will also allow the organization time to adopt new workflows and analytics regimes to ensure their 2018 MIPS performance is stellar.

2) Engage in ongoing education. Remember, the rule for 2017 will not change, but CMS will add rules and/or clarifications, as well as issuing additional details about 2018 in the near future.

3) Consider advisory consulting services to help navigate the complexities of MACRA and the QPP.

The CMS website is an excellent resource to stay informed. Allscripts has also prepared educational webinars to help navigate MACRA’s QPP and its final rule, which you can download here.

Editor’s Note: Though the Trump administration will ultimately put forward policies related to health IT, all conversations to date indicate no plan to change the path outlined for the QPP.  Regulatory deadlines remain in effect and healthcare organizations should stay the course. Jim Brulé shares some of the finer points of MACRA’s QPP in additional MACRA 101 blog posts, including:

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