MACRA

The Medical Access and Chip Reauthorization Act

The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) is the legislation that created the Quality Payment Program (QPP). It is a system of quality reporting requirements associated with ever-increasing penalties and bonuses for eligible providers (i.e., Anesthesiologists and CRNAs.)

For anesthesia practices, the easiest way to achieve MACRA compliance and participate in the CMS $500 million bonus pool is by using the “Merit-based Incentive Payment System” (MIPS) and reporting your cases via a “Qualified Clinical Data Repository” (QCDR).

Improving the Patient Experience

MACRA Compliance helps you avoid penalties and earn bonuses, but does it improve your patients' experience? Medical Business Management helps you measure and organize data to achieve MACRA Compliance AND manage your practice better.

We help you achieve:

Operational Excellence – Turn overtimes, on-time starts, prime time utilization, staffing reports, anesthesia ready times, same-day cancellations, same day add-ons, pre-assessment clinic activity, enterprise scorecards, facility scorecards, and daily analytics emails

Anesthesia Quality – Over 40 Anesthesia quality measures, automated joint commission reports, OPPE/FPPE support, surgical safety checklist rates, handoff protocol usage rates, and individual provider scorecards

Revenue Cycle Management Integration – Point of care charge capture and full revenue cycle management

Learn more about achieving MACRA compliance and qualifying for bonuses.

MBM Uses Graphium Health To Capture MACRA

Graphium Health includes features such as QCDR reporting, analytics dashboards, and joint commissions reports.

Discover Graphium Health's Reporting Software!

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MACRA FAQ's

What about PQRS, Value Payment Modifier, Meaningful Use Incentive, and Sustainable Growth Rate?

MACRA unified and replaced measures previously recorded through Sustainable Growth Rate, PQRS, Value Payment Modifier, and Meaningful Use Incentive.

What are the pathways to MACRA Compliance?

MACRA unified and replaced measures previously recorded through Sustainable Growth Rate, PQRS, Value Payment Modifier, and Meaningful Use Incentive.

Merit-based Incentive Payment System

Alternative Payment System

We focus on the MIPS pathway for reporting on individual providers.

What is at stake financially?

CMS assigns each anesthesiologist and CRNA a “MIPS Composite Performance Score” (CPS) ranging from 0 to 100. The higher your individual score, the more money you can earn. If your score were <15 for failure to report in 2019, you would have been penalized 4%. As your score rises, your penalty decreases, and you can even earn positive adjustments up to +4%.

Providers with a CPS > 70 will be deemed “Exceptional Performers” and are eligible to split an additional $500 million bonus pool courtesy of CMS. These penalties and bonuses may continue to increase over time.

How does it work?

Four components make up your final CPS. Because anesthesia is typically deemed “non-patient-facing”, the formula is different than formulas for providers in other specialties.

Quality (85%): Report on at least 6 quality measures.

Continuous Process Improvement Activity (CPIA) (15%): An assessment that you made a concerted effort to use quality feedback to improve the patient experience.

Use of Certified EHRs (0%): Exempt

Cost (0%): Exempt

What is a “Quality Measure”?

CMS controls a widely published list of quality measures referred to as “MIPS Measures.” While there are many such measures, very few of them apply to the practice of anesthesia. For instance, “MIPS 426- Handoff in PACU” is designed for anesthesia.

We recommend reporting “Non-MIPS Measures”. These become available upon registering with a “Qualified Clinical Data Registry” (QCDR). The right QCDR will greatly affect overall costs, complexity for your providers, and feasibility of becoming compliant. QCDRs tend to put their initials in front of these “Non-MIPS Measures”. For example, you may see “ASA 12: Perioperative Mortality Rate” or “ABG 14: Corneal Abrasion”. The leading initials typically indicate which QCDR “owns” the measure and is responsible for its annual certification through CMS. There are currently 5 such “Non-MIPS Measures” that must be shared between competing QCDRs.

What are Continuous Quality Improvement Activities (CPIA)?

Continuous Quality Improvement Activities (CPIA) include:

Use of QCDR data for ongoing practice assessment and improvements in patient safety

Use of QCDR data for quality improvement

Medical Business Management's EMR partner, Graphium Health, makes your QCDR data available daily to improve your patients’ experience and improve the quality of your care.

How much does MACRA compliance cost?

Through our partnership with Graphium ONE™, Medical Business Management offers MACRA compliance with the use of our iOS app for $459 per provider per year. This includes QCDR registration fees and does not require an interface with your facility or billing company. We allow for the collection of additional fields to assist in measuring your operational performance and quality (i.e., ready times, turn-over-times, etc.) at no extra charge.

Just download Graphium EMR in the Apple App Store, and you’re ready to start collecting your quality and operational data. We also offer many other services, including paper-based data collection, full tablet-based EHR, and EHR interfacing for compliance, charge capture, and operational excellence.

What steps do I need to take?

Call us to register you with a QCDR.

Decide how to collect your data: iOS App or Paper Form.

Record your quality and operational data.

Medical Business Management will handle the rest.

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Disclaimer

MACRA Compliance is an ever-moving target. We spend our days and nights reading, listening, and discussing the details of a complex program with many bureaucratic moving parts – so that you don’t have to. Our mission is to educate our clients and provide clarity in times of confusion. Your success is our success. While we strive each day to be the technology partner of choice for your anesthesia group, we have not yet found a crystal ball. The information on this page is always subject to change, courtesy of CMS.