DESTIN, Fla. — At the Congress of Clinical Rheumatology Annual Meeting, William F. Harvey, MD, MSc, FACR, from Tufts Medical Center, discussed what rheumatologists should know about the 2015 Medicare Access and CHIP Reauthorization Act.
In 2019, there will be two new MACRA pathways: merit-based incentive payment system (MIPS) — the default pathway if the physician does nothing — and alternate payment models (APMs), Harvey said. Harvey noted MIPS has four components for its composite performance score, which ranges from 0 to 100. The four components are quality (60%), resource use (0%) — which will become a component in the future — clinical practice improvement activities (15%) and the advancing care information for meaningful use (MU) electronic health record (EHR; 25%). On Jan. 1, 2017, practice data began to count for the MIPS. The MIPS performance threshold is a score of 3 out of 100, and the high threshold is 70 out of 100. Physicians with scores of less than 3 receive the highest penalty, so Harvey said physicians just need to report some data at any point in 2017 to avoid negative payment adjustments in 2019.
William F. Harvey
The quality component includes BMI screening; a medication list; tobacco screening; hypertension screening; consultation notes sent to the referring physician; tuberculosis screening for patients who take biologics; and rheumatoid arthritis (RA) disease activity, functional assessment, prognosis and steroid management. Rheumatologists need to report on just six of these measures, each worth 10 points. For each measure, rheumatologists will receive 3 points for reaching the benchmark and 4 points to 10 points based on decile performance compared with all reporting. Resource use and cost will not be measured in 2017.
Practice improvement includes more than 90 activities, which include participation in a data registry, such as RISE.
MU requires EHR security risk analysis, e-prescribing, patient access to electronic records, sending a summary of care and accepting a summary of care. As optional metrics, there is patient-specific educational information, secure messaging, patient-generated health data, medication reconciliation and immunization registry reporting. Of 155 possible points, 50 points can be earned for reporting five measures; 90 can be earned for performance based on decile; and 15 bonus points can be earned for additional public health reporting, EHR reporting or registry use. These 155 points will then be scaled back to 100 and count for 25% of MIPS.
To qualify for an APM — which includes accountable care organizations, bundled payment models and patient-centered medical homes — there must be certified emergency medical record technology, quality measures similar to MIPS and risk-bearing metrics. There is a 5% annual bonus to join an APM between 2019 and 2024. However, fewer than 10% of accountable care organizations currently qualify. As a result, the ACR has created a working group to develop an APM for rheumatologists.
As for what rheumatologists can do now, Harvey said they can join the RISE registry; begin reporting on MU; start reporting physician quality reporting system measures; view quality resource; and use reports. – by Will A. Offit
Harvey W. Holy MACRA; April 27-20, 2017; Destin, Fla.
Disclosure: Harvey reports no relevant financial disclosures.