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Avoid MU Penalties – and Understand MACRA 2.0

July 1 is the deadline for avoiding the 2018 penalty imposed by the federal government’s Electronic Health Record (EHR) Incentive Program in its final year. If you were not successful in reporting Meaningful Use in 2016 (the performance year for the 2018 penalty), it’s an opportune time to apply for the hardship. The application takes only minutes to complete and submit. Review the criteria for applicability, noting that, for many, if not most, physicians, category 2.2.d will apply. With only a few days left before the deadline, do not delay.

This week, the Centers for Medicare & Medicaid Services (CMS) issued the proposed rule about the upcoming performance year under the Quality Payment Program (QPP) formulated by 2015’s Medicare Access to Care and CHIP Reauthorization Act (MACRA). The most important announcement is that many physicians – another 30%, as estimated by CMS, joining the already-exempt 35% – will not have to participate in the program. The threshold – as measured by total allowed Part B charges – is raised from $30,000 to $90,000 in the proposal. If receiving less than $90,000 in total allowed Part B charges, you would not have to participate, nor would those who see less than 200 patients. This leaves only an estimated 36% of the nation’s clinicians eligible for the QPP.

Physicians in small practices who do meet the participation threshold (with more than $90,000 in Part B total allowed charges or those who see more than 200 Medicare patients during the reporting period) can declare a hardship exemption for the Advancing Care Information (ACI) category. (Small practices are considered 15 clinicians or less; ACI is the new name for Meaningful Use.)

In addition to the multitude of physicians who would be exempt, another big win is the agreement to continue to allow the use of a 2014 edition of an EHR system. This is critical news for many practices that are being pressured by vendors to purchase the updates or upgrades required for the 2015 version. Remarkably, the prices often far exceed any gains available by the government’s new program. For practices experiencing even more challenges with their vendors – the system has become “decertified” – CMS is proposing an exemption that would be retroactive to the current (2017) reporting year.

The proposed second year of the QPP also features:

  • Virtual groups, a concept that was highlighted in the original program but is now coming to fruition, which allow non-affiliated physicians of any specialty to band together to participate;
  • Bonus points for small practices, as well as points in the Quality category for attempting to report, as well as those who treat “complex patients” as defined by their average Hierarchical Conditions Category (noting that this is formulated based on reported ICD10s);
  • Flexibility for facility-based clinicians;
  • Allowing QPP-exempt physicians (see above) to opt in if they so choose;
  • Permitting the use of multiple submission mechanisms even within a single category (for example, measures could be transmitted via an EHR and a registry for the Quality category);
  • Continuation of the three-point floor for each quality measure, with the exception of those that do not meet the data completeness requirements and are not a small practice, coupled with a maximum of only six points for those measures that are “topped out” (compared to a potential 10 for all others);
  • Exclusion of the Cost category for the 2018 performance year, compared to the 10% weight originally suggested; and
  • Addition of exclusions for the summary of care record exchanges and e-prescribing in the Advancing Care Information category.

There are many other proposed changes in the newly released rule. Only time will tell which ones will stick, however, the 1,058-page proposal provides evidence of the government backing off this new program. For those physicians who remain eligible, however, it appears that you’ll continue to be faced with a tangled web of ever-changing rules to follow in order to be successful.

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Woodcock & Associates: Changing the Way You Work