By Dr. Michael McMurtry
From the March 2017 issue of DOTmed HealthCare Business News magazine
With the issuance of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaced the Sustainable Growth Rate (SGR) and rolled multiple quality reporting programs into a single system, cardiology service lines are more dependent than ever on accurate and complete data capture.
It’s a challenge with which many continue to struggle, and for which they have little time to overcome. Performance in the current year will be the basis upon which 2019 payments are adjusted. Those cardiologists and cardiology service lines that aren’t prepared with vastly improved reporting capabilities could potentially take a significant financial hit as penalties and bonuses phase in over time — starting with a bonus of up to 4 percent in 2019.
A MACRA/MIPS primer
MACRA includes two programs: The Meritbased Incentive Payment System (MIPS), which rolls together the Physician Quality Reporting System (PQRS), Value Modifier and the Electronic Health Record (EHR) Incentive Program and allows providers to earn payment adjustments by demonstrating the provision of high-quality, efficient care based on quality reporting, resource utilization, clinical practice improvement and advancing care information; and the Advanced Alternative Payment Model (Advanced APM), which lets providers earn greater incentives for providing high-quality, cost-efficient care by taking on some risk related to patient outcomes.
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Most cardiologists are expected to participate in MIPS, under which they will be assessed based on performance against quality measures developed by the American College of Cardiology (ACC), American Heart Association (AHA) and other stakeholders. Part of its appeal is familiarity, as most of the quality measures under MIPS are currently reported under the PQRS. But the stakes are now much higher, with quality reporting counting as 60 percent of the provider’s MIPS composite score.
While MACRA/MIPS is currently front and center in discussions around quality reporting, the impact of accurate and comprehensive data capture and documentation goes much deeper for cardiology. A plethora of new mandates, harsher penalties and reimbursement opportunities — a more attractive Chronic Care Management program, increased penalties for preventable 30-day readmissions, the ongoing threat of RAC and other regulatory audits, cardiac bundled, Appropriate Use, etc. — have ratcheted up the pressure to adopt structured reporting.