ACHE 2017: Making a ‘game plan’ for MIPS, MACRA

 - Graham Fox, senior manager at Pershing Yoakley and Associates (PYA)
Graham Fox, senior manager at Pershing Yoakley and Associates (PYA)

Physician infighting and poor scores are just some of the negative outcomes awaiting healthcare leaders who don’t adequately prepare for the new Merit-based Incentive Payment System (MIPS). Speaking at the American College of Healthcare Executives (ACHE) Congress in Chicago, healthcare consultants made the case for those in the C-suite to quickly get their MIPS “game plan” in order.

Martie Ross, principal at consultant company Pershing Yoakley and Associates (PYA), said the remedy to many issues with the Medicare Access and CHIP Reauthorization Act (MACRA) is “education, education, education.” Even though many physicians are reporting they’re unfamiliar with the law, leaders have to make decisions which could create considerable tension between clinicians.

One of those decisions will be whether to report in MIPS as a group or as individual clinicians. Ross explained it was an all-or-nothing scenario, meaning if you report as a group in one category, you report as a group in all of MIPS, and each of the individual scores generated for the group’s clinician will just be a repeat of the entire group’s score. She said that’s already starting “food fights” between doctors.

“They’re all convinced that one of their partners is going to drag their score down,” Ross said, adding doctors may have the suspicion about new physicians in the group, potentially slowing down recruitment.

As one audience member cracked: “So your colleague can really screw you.”

The individual-versus-group reporting decision also affects the low-volume threshold in MIPS. Clinicians are exempt from MIPS in 2017 if they receive under $30,000 in Medicare Part B charges or treat fewer than 100 Medicare patients. That exemption is judged at the reporting entity level, so those reporting in a group are far less likely to be exempt, even if those clinicians may be exempt individually.

“You get to four-person group, you almost automatically go over the threshold,” Ross said. “This is happening for rural health clinics. None of those individual physicians are going to have very many Part B charges, but when they aggregate everything ... all of a sudden you’re way above $30,000 for that group.”

Another crucial decision execs will need to make is how their clinicians report to MIPS. PYA Senior Manager Graham Fox emphasized that the exact same performance can lead to different point total based on the method of submission. For example, a higher score may be achieved by submitting through an electronic health record versus claims data.

“You can’t get blinded by your performance scores and think ‘Oh, that’s an A.’ It may not be,” Fox said.

Beyond education, the type of reporting and the submission method, healthcare leaders have many other decisions to make to prepare for MIPS, like: selecting what quality metrics and improvement activities to use, what level of “pick your pace” reporting options to undertake in 2017 and preparing for cost performance reporting being added in 2018.

All of these decisions will factor into the publicly published scores on Medicare Physician Compare. According to Fox, leaders should be concerned with how that data will affect decisions by patients and business partners.

“Might that [score] color the conversation in that acquisition or even recruitment?” Fox said. “If it’s public knowledge, you better bet our payors and our provider networks are also looking at that data.”