The Center for Medicare and Medicaid Services (CMS) has announced significant updates with regards to its value-based care programs. Of these programs, MACRA, the Medicare Access and CHIP Reauthorization Act, represents a highly innovative legislative measure to encourage quality care among CMS-reimbursed physicians. In 2016, MACRA formed distinct payment pathways for physicians such as the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs) program. The following article will discuss 2018 updates to MACRA and MIPS, including the mechanisms by which such updates will affect providers and practices at-large.
For individual practitioners, reporting requirements under MACRA will significantly increase in 2018. To begin, a physician or practice’s score is calculated predominantly using scores for quality. In order to have a score included in the total score, CMS requires clinicians to achieve certain data submission requirements by utilizing a data completeness measure. Data completeness is essentially the percentage of viable data that a physician submits to CMS upon time for review. In 2017, the threshold for data completeness was set at 50%, however for 2018 CMS has increased this threshold to 60%. This shift reflects the trend at CMS to bolster the repository of claims data from a variety of healthcare institutions in the U.S.
In addition to increased data reporting requirements, CMS will commence their inclusion of cost as a measure for MIPS scoring, a dramatic shift from the initial MACRA policy. At the onset, the inclusion of cost measures in MACRA/MIPS evaluations was set to occur in 2019 and has now been moved forward by one year. For MIPS scoring purposes, cost metrics will contribute to 10% of the total score. Furthermore, points for cost will be evaluated by measuring Medicare Spending Per Beneficiary (MSPB) and cost per capita of the reported patient population. Once the data is submitted, CMS will independently perform the cost calculations for scoring purposes. CMS aims to double the cost scoring contribute to MIPS in 2019. Essentially, this program year will serve as a pilot of sorts for CMS to test the processes and validity around measuring, evaluating, and including cost in MIPS.
Furthermore, CMS has made an intentional effort to respond to the array of natural disasters that occurred in the United States throughout 2017. Practices that are based in areas that were impacted by natural disasters in 2017 may submit a hardship exception application that will excuse a decline in meeting data or reporting requirements and negate any late penalties for reporting data.
To conclude, MACRA and MIPS updates for 2018 are significant in advancing the value-driven agenda of CMS. Future developments will continue to improve evaluation processes, thus advancing value as the center of the U.S. healthcare system.