MACRA 2019: The High Cost of Non-Compliance

The protection, security, and accurate transmission of information are some of the most crucial features of effective anesthesia care. One mismarked chart or misread note can potentially lead to catastrophe. Interpretation is not the same as precise duplication! The best way to avoid playing a game of “Telephone” with your patient information is to ensure MACRA compliance with simple reporting solutions. Not only is non-compliance dangerous for your patients, but the ever-rising costs of penalties – up to -7% of Medicare charges in 2019 – can also be dangerous for your bottom line.

It’s all about your CPS

For the third year in a row, most anesthesiologists & CRNAs will be participating in a Merit-based Incentive Payment Program (MIPS). A Composite Performance Score (CPS), earned by every Anesthesiologist and CRNA, is the primary method used to gauge MACRA compliance, and thus scale the size of your bonus.

On a scale of 0 – 100, each of your providers is rated based on the following criteria:

Quality – 70% of your score for 2019
While there are many ways to transmit your clinical data, Qualified Clinical Data Registry Reporting (QCDR) gives anesthesiologists and CRNAs the best chance of receiving the maximum bonus, estimated to be at ~5% for 2019 for most providers. By collecting data on 7 measures, but only reporting the best 6, you get the best possible score.

Promoting Interoperability – 0% of your score for 2019
This portion is usually waived by default and does not apply to “non-patient facing” providers, such as your typical anesthesiologist and CRNA. Instead, this typical 25% portion is “moved” to the Quality portion, thus raising the Quality category weight from 45% to 70%. Only certain specialists, such as Pain specialists and Critical Care Medicine Specialists, will not have this exemption.

Improvement Activities – 15% of your score for 2019
This section mainly consists of showing how collected patient data was used to improve patient outcomes. While you only have to attest that you completed these activities over a 90 day period, beware of not providing accurate documentation of outcomes, as you will need this in the case of an audit.

Cost – 15% of your score for 2019
The two performance measures in this category are Medicare Spending Per Beneficiary (MSPB), and Total Per Capita Cost (TPCC). You don’t have to report any of this data, as administrative claims are used to attribute costs to providers. If your cost score cannot be calculated, this category is reduced to zero, and the weight of the Quality category increases.

You have help

If all of these acronyms stress you out, not to worry. There are many providers offering services to help monitor these measures, as well as analytics dashboards which allow you to track, trend, and share performance reviews in a way that makes sense. Your CPS can be a powerful tool to ensure patient safety, guarantee MACRA Compliance, and provide extremely valuable quality data to your hospital administration.

Contact us to learn more about MACRA Compliance for 2019 and ensure your practice is getting the maximum bonus!