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MACRA for Anesthesia Basics

Just the facts you need to know about how MACRA applies to the practice of anesthesia.

2018 MACRA Overview

The focus of MACRA compliance will remain primarily on quality reporting via Qualified Clinical Data Registries (QCDR). Specifically, the up to 6 quality measures should be reported for every case you perform to maximize your final Composite Performance Score (CPS) and avoid an upto 5% penalty on your Medicare Part B claims in 2020.

Last year, MACRA replaced the Sustainable Growth Rate formula. By replacing 3 more familiar programs: “PQRS”, “Value Payment Modifier”, and “Meaningful Use”, MACRA will continue to assist government’s desire to reduce cost and improve outcomes across the healthcare landscape, including Anesthesia.

By becoming MACRA compliant you can both avoid 5% penalties and perhaps participate in part of a $500 million bonus opportunity. It’s not that you have to make significant changes to your current anesthesia practice. You just need to know how and what to report. That’s where Graphium helps.

There are 2 ways to participate in MACRA: The Alternative Payment Model (APM) and Merit-based Incentive Payment System (MIPS). MIPS will be the dominate way of maximizing reimbursement and is the focus of our approach to compliance for anesthesia.

To this end, there are 4 components of MIPS compliance: (1) Quality (75%) (2) Improvement Activities (15%) (3) Advancing Care Information (0%), and (4) Cost (10%).

Both of our MACRA Ready™ Simple and Plus plans will exceed the minimum standards in order to maximize your MIPS Composite Performance Score (CPS). Our platform offers you the opportunity to achieve far more than mere compliance.

We offer an unparallelled view into Operational Intelligence. Our Dashboards, Daily Emails, and Enterprise Scorecards will enable you to redefine how you manage your business.

Your Goal

Maximize each provider’s Composite Performance Score (CPS).

Your CPS will be assigned at the end of the year and range from 0-100. The higher your score, the lower your penalty and the higher your bonus for services rendered in 2020. The providers who pay the penalty will actually be paying the providers who earn the bonus. In other words, this is “budget neutral” for CMS. The bonus money comes from the penalties of others.

There is also an additional CMS bonus pool of $500 milion to be distributed amoung all “Exceptional Performers”, defined as any Provider with a CPS greater than 70.

In 2018, the reporting period has been increased from 90 days back to 12 months, regardless of your reporting methodology. When reporting via a Qualified Clinical Data Registry (QCDR) – by far the easiest way to ensure a maximum CPS – you must report on over 50% of all patients over the reporting period. Get started now to ensure the best chance of success!

4 CPS Components

1. Quality

75% of your score.

You can only submit a maximum of 6 “Quality Measures“, and you get points for each measure submitted.

The amount of points you get for a given measure depends on 2 factors:

What is your final “Performance Met” for the given measure?

How does it compare to the national reported average for that same measure?

For example, if your Performance Met was 98% and the national average for that same measure was also 98%, then you would receive half the number of available points for the measure.

2. Improvement Activites

15% of your score.

You will earn these points through a simple attestation for the entire group at the end of the year. The basic intent here is to encourage you to use this quality data to improve your surgical patient experience.

There are ~100 activities defined by CMS and each is “worth” a certain number of points. You need enough activities to acquire 40 points in order to receive full credit for this portion of your CPS.

Three activites, specific to anesthesia include:

  • Use a QCDR. (10 points)
  • Use the QCDR data to compare providers and improve patient care. (10points)
  • Use the QCDR data to review population health of your patients. (20 points)

Use of the Graphium platform and approach will provide you the opportunity to positively attest to each of these 3 activities.

3. Advancing Care Information

0% of your score .

Anesthesia providers are classifed as “non-patient facing”, and thus, they are exempt from this portion of the CPS. Consequently, the Quality portion of the score increases from the more familiarly quoted level of 60% to 75%.

4. Cost

10% of your score.

CMS is calculating this portion of the score on their own. There is no additional data submission needed from your practice.

What’s a “MACRA Quality Measure”?

Quality Measures account for 75% of your Composite Performance Score (CPS), and you can only report a maximum of 6 measures. Quality Measures come in 2 flavors: “QCDR Measures” or “MIPS Measures”. They have some very important differences.

“QCDR Measures” (also called “Non-MIPS” Measures)

These are owned by individual Qualified Clinical Data Repositories (QCDRs). These private entities apply for certification with CMS every year, and every year, CMS needs to recertify each of their measures. In order to report “QCDR Measures”, we will register your providers with the QCDR and simply pass on any registrations fees directly to you. These “QCDR Measures” are designed specifically for general anesthesia practice and make finding 6 applicable measures for the Quality portion of your CPS much easier.

“MIPS Measures”

These are directly owned by CMS and carry the additional data burden of requiring CPT codes for each case. That is, the denomitator exclusion criteria for any given MIPS measure is a function of the CPT code for the case. This code is often not available for days after the completion of the procedure, and thus indirectly increases the costs associated with using these measures. There is no advantage, per se, to using MIPS measures over QCDR measures.

Comparing QCDRs

There are over a hundred QCDRs in the market, but only several for anesthesia. Some of these require the use of a particular billing company or are available only to certain national anesthesia groups.

The vast majority of the market has only 2 QCDR options: Anesthesia Business Group (ABG) or Anesthesia Quality Institute (AQI). Both have pros and cons, with different measures and different registrations costs. Graphium Health is not a QCDR. Being QCDR independent allows us to give you the best reporting option each year. We are constantly reviewing the market, finding the easiest path for your anesthesiologists and CRNAs to be MACRA compliant.

Learn More

MACRA compliance for Anesthesia quickly gets confusing and expensive to ignore. Our team would like to help you navigate these waters with confidence and success.

Let’s us know a bit about you, and we’ll reach out. We look forward to meeting you!

2018 Anesthesia MACRA Compliance

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