4 Steps to Prepare for Medicare's New Payment Systems

While the details of the Medicare Access and CHIP Reauthorization Act (MACRA) regulations still are being hammered out, physicians should start preparing for the new payment systems now. Make sure you’re on track by taking four important steps.

The lengthy proposed rule released by the Centers for Medicare & Medicaid Services (CMS) outlines the draft regulations the agency is considering for implementation. This is just the beginning of the official rulemaking process, but what is known for sure is that physicians will have a choice in whether to participate in the Merit-based Incentive Payment System (MIPS) or meet requirements for an alternative payment model (APM).

Here are the steps you can take to prepare your practice for one of the two new Medicare paths:

  • 1. Review your quality measurement and reporting. Understanding current quality reporting requirements and how you are scoring across both the Medicare Physician Quality Reporting System (PQRS) and private payers will help your practice be better suited for the upcoming changes.

    You also should try to access and review your Medicare quality and resource use reports (QRUR) to see where you can make improvements related to cost ahead of time. Two particularly important components to identify as you prepare for meeting the care coordination requirements are: (1) your most costly patient population conditions and diagnoses, and (2) targeted care delivery plans for these conditions.

    Tip: You can access your 2014 annual PQRS feedback reports and QRURs on the CMS Enterprise Portal using your Enterprise Identify Data Management account. Learn more about how to access these reports. If you are part of a large practice or health system, you may need to talk to your administrator about accessing your QRUR.

  • 2. Understand your patient data and benchmarks. Data registries can streamline reporting and improve performance scores. If you are not already participating in a patient clinical data registry, contact your medical specialty society to discuss how to participate in theirs. There also might be regional registries relevant to your practice.

    Tip: You can view a list of 2016 CMS-approved qualified clinical data registries and contact information on the CMS website.

  • 3. Check on your electronic health record (EHR). If your practice uses an EHR, contact your vendor to discuss how its product supports adoption of new payment models.

    Make sure your EHR is certified to the Office of the National Coordinator for Health IT’s (ONC) 2014 or 2015 certification requirements. Using a 2014 or 2015 edition EHR is essential for participation in either MIPS or APMs.

    Ask your vendor when they will update your software to the 2015 certified edition and whether reporting quality measures through the EHR is a viable option based on the proposed MIPS quality requirements.

    Tip: You can check your product’s certification in a listing by the ONC.

  • 4. Stay informed. There are several ways to keep your practice up-to-date on the new regulations:

    • Stay connected with the AMA for tools to assist you in implementation. Watch AMA Wire® to learn about a free online individual practice readiness assessment tool that will launch this summer.

    • Contact your medical specialty society or state medical association to find out if there are APM opportunities for your practice and how you can get involved in their development.

    • Seek out local support for your quality improvement activities. Practice transformation networks and regional health improvement collaboratives provide resources and technical support.

      For more information on how to prepare for the new Medicare payment systems, review the AMA’s MACRA checklist, or check out the AMA’s STEPS Forward™ collection of practice improvement strategies that can help your practice prepare for value-based care.