National Council for Behavioral Health

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Elizabeth Arend, MPH

Quality Improvement Advisor

Confused about MACRA? We’ve got you covered

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Over the last month, the National Council held three webinars to shed some light on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the sweeping reforms it makes to payments under Medicare Part B.

The first webinar, “MACRA 101,” provided an overview of CMS’s proposed Quality Payment Program, which completely overhauls how Medicare Part B clinicians will be paid starting in 2019. The MACRA proposed rule outlines two possible paths to payment—Advanced Alternative Payment Models (APMs), and the Merit-Based Incentive Payment System (MIPS). Because Advanced APMs must use certified electronic health record technology (CEHRT) and assume “more than nominal financial risk,” it will not be an option for the vast majority of clinicians. In 2017, CMS predicts that 92 percent of eligible clinicians—including behavioral health care providers—will be subject to MIPS.

The second webinar therefore provided an in-depth look at MIPS and how clinicians will be assessed when it goes into effect on January 1, 2017. MIPS consolidates three current quality reporting programs, while adding a fourth category:

  • The Physician Quality Reporting System (PQRS) becomes Quality and requires eligible clinicians to report certain quality measures on an annual basis.
  • The Value-based Payment Modifier Program (VM) becomes Resource Use and compares costs to treat similar care episodes and clinical condition groups across practices.
  • The Medicare Electronic Health Record (EHR) incentive program becomes Advancing Care Information and retains an emphasis on interoperability and information exchange.
  • A brand-new reporting category is Clinical Practice Improvement Activities, which rewards practices that engage in quality improvement activities, including for their Medicaid and other non-Medicare patient populations.

Each of these four categories will be weighted and collectively form a Composite Performance Score (CPS) on a scale from 0-100. The CPS will be used to compare practices and inform payment adjustments for eligible clinicians in 2019. Based on 2017 calendar year reporting, MIPS-eligible clinicians will receive up to a +/- 4.0% positive, neutral or negative payment adjustment in 2019. The range of payment adjustments will reach +/- 9.0% by 2022.

To help behavioral health organizations prepare, the third webinar in the series featured three guest speakers from different behavioral health organizations. They discussed how they currently participate in CMS quality reporting, the challenges they’ve faced, and how they’re applying the lessons they’ve learned to prepare for MIPS.

You can view the webinar recordings, along with the National Council’s new MIPS Resource Guide and MACRA Fact Sheet at Stay tuned for additional resources and updates after the final rule (which is expected November 1, 2016) is published.