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MACRA: Looking Back and Looking Ahead to 2018: Page 2 of 4

MACRA: Looking Back and Looking Ahead to 2018: Page 2 of 4

Lessons Learned

Looking back at 2017, Beth Houck, vice president of client services at Chicago-based consulting firm SA Ignite, says she has found physicians confused about not just looking at performance, but having to look at performance against a benchmark as they choose which quality measures to report on.

For example, Houck says small specialty practices tend to default to claims-based reporting because that is familiar to them and they know they can get the claims data. But in MIPS those have the highest number of "topped-out" measures. (A measure might be considered topped out if performance is so high and unvarying that meaningful distinctions and improvements in performance can no longer be made.)

Trying to improve on topped-out or nearly topped-out measures gives clinicians little to no opportunity to improve their MIPS score, because their performance cannot be significantly above the benchmark, she explains. Plus, a topped-out measure is more likely to be dropped from the measure set in the future, so any work done to improve on topped-out measures will not yield much benefit. Houck stresses that organizations should focus their efforts on measures where clinicians are performing well relative to the benchmark, not necessarily the highest-scoring measures, and project how improvements on those measures will impact their scores.

Some small practices are disheartened by the complexity of MIPS and although they participate in accountable care organizations (ACOs), those ACOs don't yet have the volume of patients to qualify as APMs. Kyle Matthews, CEO of 14-physician Phoenix Heart PLLC, in Glendale, Ariz., says his physicians are determined to do the minimum to avoid a MIPS penalty but otherwise are seeking to avoid the program.

Phoenix Heart cardiologists did an analysis and determined they would have to hire one or two more staffers to handle the administrative burden of MIPS. "You hire one nurse practitioner and a couple of new staff members and you have already taken up anything you could possibly make in bonuses," Matthews says. "We could get that 3- or 4-percent bonus, but we would have eaten up all that bonus money with the hires. My doctors are about to throw their hands in the air and say forget all this EHR stuff anyway because it slows them down. They have done it for years to avoid penalties, and they just do not want to do it anymore. It is not worth it to them. It is no longer an issue of how much bonus money can we get. It is becoming a quality-of-life issue and one that impacts patient care."

It is likely that many providers were relieved when the 2018 proposed rule called for expanding the low-volume threshold for exclusion from MIPS reporting to groups with less than $90,000 in Part B allowed charges or fewer than 200 Part B beneficiaries. This was confirmed by the final rule in early November, when CMS projected that 60 percent of clinicians billing Medicare Part B will be able to skip MIPS.

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