MACRA and MIPS: What to know for 2017

As we usher in the new year, we thought we’d note one of the most important policy changes: MACRA. While MACRA was first signed into law in early April of 2016, it has yet to be fully implemented. However, after laying much of the groundwork for the bill, the healthcare industry will now be easing itself into the new requirements.

What are MACRA and MIPS?

MACRA stands for The Medicare Access and CHIP Reauthorization Act (2015). It is bipartisan legislation that is designed to improve the quality of patient care in the healthcare industry. It does so by rewarding providers for the value they provide rather than for the volume of patients they see. The better the care, the more compensation the provider receives. If the care is deemed subpar, the provider will receive less compensation. By shifting from quantity-driven care to quality-driven care, the thought is that the healthcare industry as a whole will progressively improve across the board. Most importantly, this change will almost certainly positively impact the overall care that a patient receives – which is, of course, the main goal of every provider.

MACRA isn’t only focused on improving the patient side of healthcare, though. Many leaders believe that the eventual outcome of the bill will be cost-reduction, more effective resource use, improved healthcare efficiency, and a much higher ROI on Electronic Health Records (EHR). Though providers are not going to be negatively punished for falling short of these requirements this, providers who fail to report anything in 2017 could be subject to the maximum penalty (4%) in 2018. These first few years are just the slow beginning for the MACRA, but it is expected to be fully implemented by 2019. In 2019, providers will be judged on a composite score based on the following criteria known as MIPS (The Merit Based Incentive Payment System):

  • Quality (vs. Quantity) of care
  • Resource Use
  • Clinical Practice Improvement
  • Meaningful Use of Certified EHR

A provider’s MIPS score will determine the compensation they receive for the following year. An interesting note on the MIPS score is that the weight of each criteria will shift each successive year based on the overall goals of MACRA. See the image below to understand how the weighted criteria will differ from year to year.


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As you can see, there is a major emphasis on pushing for a large boost in quality score from the outset. Therefore, it’s beneficial for providers to start focusing on value over volume as soon as possible. ACI (Advancing Care Information) and CPIA (Clinical Practice Improvement Activities) will remain the same every year.

How can Virtelligence help with MACRA?

Improving patient care is paramount for MACRA success, and our healthcare IT consultants understand how to improve patient care through technology. For nearly 20 years, we’ve been successfully partnering with some of the largest hospitals and health systems in the world. Our expert EHR staff are certified in every major EHR system, and they are constantly training to stay up to date on industry best practice. One of the most crucial aspects of a successful MACRA plan is to have a finely-tuned EHR system. In addition to our EHR consultants, we also staff highly qualified Project Managers and Strategic Guidance consultants, as well as Meaningful Use specialists. Whether MACRA is pushing your organization to implement a new EHR system, optimize your current EHR software, or launch a MACRA-specific project – Virtelligence can help you every step along the way.

Don’t get left behind. Start your 2017 off right with a MACRA strategy that will set your organization up for success in the years to come. Contact our leadership team today to find out how we can help keep you on track.

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