MACRA, MIPS, & Your Practice

Medicus IT

By Medicus IT

The Merit-based Incentive Payment System (MIPS) has been in effect for a while, and we are going to expand on our last blog post to explain how the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) affects how your practice will qualify for bonus funds from MIPS. 


First, we need to explain what MACRA is and how it works. Some of the things that MACRA has done is it

  • Repealed the Sustainable Growth Rate (SGR) formula previously used by MIPS.
  • Changes the way that Medicare rewards clinicians for value rather than volume.
  • Streamlines the numerous quality programs that were currently under MIPS.
  • Provides bonus payments for participation in eligible alternative payment models (APMs).
  • Removes sensitive patient information from their Medicare cards.

So how does it work and what benefit could this have for your practice? Well, the whole idea around the MACRA program is to incentivize the elevation of the quality of care and encourage healthcare providers to move away from the volume-based idea. By removing the volume-based incentives and replacing them with quality-based incentives it allows healthcare providers to increase the quality of the care they provide to their patients. Not only do MIPS and MACRA help promote better care, but they also intend to enhance the quality care over time with a structured system. You may think, “that sounds great, but how does it work?” So first MIPS and MACRA have a quality score that determines if you are in the high-quality care pool or not. If not, they provide solutions to help increase the quality of your care so that you can move into the high-quality care pool. Once in this pool, your practice qualifies for bonus money for having such a high quality of care. The score requirements to be eligible for the bonus increases year over year, which means to maintain your position in the high-quality pool you will need to increase your quality of care. As the quality score requirements increase, so do the bonus funds available.

Four factors determine the quality score. The factors include Quality, Promoting Interoperability, Improvement Activities, and Cost. The sum of all these scores equals 100 points, and this is how your quality score is calculated. The calculations for this score will continue to adjust over the next few years. For 2019 the weighted scores are split accordingly,

  1. Quality – 45%
  2. Promoting Interoperability (PI) – 25%
  3. Improvement Activities (IA) – 15%
  4. Cost – 15%

As we can see, MIPS and MACRA create opportunities for your healthcare practice not only to increase the quality of the care you provide to your patients but also increase the revenue of your practice year over year. As long as you continue to improve your quality score and hit the high-quality pool qualifications, you will get your bonus. This system seems complicated at first glance, but once you look into the details and understand how it can help your practice, it’s a no brainer.

Quality of care can be affected by many things, including technology and here at Medicus IT, we specialize in healthcare-specific IT solutions. We can help streamline, stabilize, and secure all your technology so that you can focus on what matters, the quality of care for your patients. So why not take advantage of our free network assessment today?

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