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    MACRA changes deemed likely to survive new administration


    “You might be in a Medicare Shared Savings program ACO,” Dr. Williams said. “You might be contracted into one. And if you are, your quality reporting is through the ACO and the rules are very complicated. You still have to do MIPS but there may be a blended reporting requirement.”

    Medicare Shared Savings is one example of a trend for Medicare and other payers to shift financial risk to physicians, Dr. Williams said.

    MIPS does not affect ophthalmologists much in its current form, but “since the agenda is there,” ophthalmologists should understand it, Dr. Williams said.

    Under MIPS, physicians could receive bonuses or penalties up to 4% of their Medicare reimbursement. This compares with bonuses or penalties that could range as high as 27% under previous regulations, Dr. Williams said. “So this is a much less onerous system.”

    In its current configuration, MIPS awards 60 points for quality reporting in a system similar to the physician quality reporting system (PQRS) used before MACRA. 

    It awards up to 25 points for electronic health records in a program known as “Advancing Care Information (ACI)” which takes the place of “meaningful use.”

    And it awards up to 15 points for clinical practice improvement activities (CPIA).

    (A fourth category, resource use, was eliminated because the Centers for Medicare and Medicaid Services (CMS) couldn’t find workable standards, said Dr. Williams.)

    Quality reporting is “super easy in 2017,” Dr. Williams said.

    Currently, physicians need only report on a single outcomes measure to get the full 60 points. Still practices may benefit by reporting more outcomes measures to gain a better understanding of the system, she recommended.

    Practices have to report quality measures on at least 50% of their Medicare patients, and they must have at least 20 patients. They are only required to report for 90 days. But Dr. Williams has asked Wheaton Eye Clinic physicians to report for a whole year on 7 outcomes measures.

    Mechanisms for reporting to MIPS vary depending on the way practices track data.

    “The most elegant way” is to integrate electronic health records with the American Academy of Ophthalmology’s Intelligent Research in Sight (IRIS) registry, Dr. Williams said.

    But it’s also possible to report through an electronic health records vendor.

    Requirements for electronic health records are simpler than they were under meaningful use, and CMS is allowing practices to apply for exceptions to the requirement, she said.

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