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    MACRA changes are part of volume-to-value shift

    Clinicians need to understand system basics, reporting requirements; consider new models


    Barring any legislative action, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) and MIPS (Merit Based Incentive Payments System) will continue to be part of life for ophthalmologists for years to come. While the American Academy of Ophthalmology continues to assess the goals and guidelines within MACRA and evaluate options such as alternative payment models (APMs), Academy CEO David W. Parke, II, MD, urged ophthalmologists to fully participate in the MIPS reporting program and to avail themselves of resources to learn more about its complexities.

    The premise of the changes set in motion by MACRA is a shift from volume to value. “The key thing to me, and this is always worth remembering, is that value is defined as the healthcare outcomes achieved per total dollars spent on any given set of services,” Dr. Parke said.

    The intent is to drive physicians out of traditional fee for service medicine through either the MIPS or APM pathway. However, APMs, particularly advanced APMs, have little to offer most specialists unless they are engaged in a large, integrated system or accountable care organization, Parke said, adding that data suggest that the vast majority of physicians will still be in MIPS for the foreseeable future. APMs have not been developed for most specialties that comply with MACRA program requirements and are clinically valid and relevant.

    In 2017, the highest weighted component of MIPS was quality measurement (60%), while resource use accounted for 0% of the final performance score; clinical practice improvement activities and advancing clinical information made up the remaining 40%. However, the policy goal is for quality measurement and resource use to ultimately become the two most significant components of payment.

    Dr. Parke urged physicians to report quality measures for a full year in 2018 and to report on at least two outcomes to reduce the likelihood of financial penalties and increase the possibility of a bonus. Although reporting on just one patient a year qualifies for 2018 reporting, this gives physicians no margin of error, he added, recommending more substantive participation.

    Nancy Groves
    Nancy Groves is a freelance medical writer.

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