MACRA 2.0 and Beyond: Preparing Your Practice to Meet the Quality and Reporting Challenges

At the 2017 American Society of Clinical Oncology Annual Meeting, oncologists heard from fellow experts on the best way to navigate this daunting payment reform challenge.
Published Online: June 05, 2017
Published By: Surabhi Dangi-Garimella, PhD
Whether or not oncologists want to, CMS’ new payment model, the Medicare Access and CHIP Reauthorization Act (MACRA), is now live. MACRA replaced the Sustainable Growth Rate formula through the Quality Payment Program (QPP), which includes 2 tracks: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). At the 2017 American Society of Clinical Oncology (ASCO) Annual Meeting, oncologists heard from fellow experts on the best way to navigate this daunting payment reform challenge.

The learning objectives of the session included the practice impact of MACRA, quality reporting and/or APM options under MACRA, and the impact of APMs on the Medicare.

Blase N. Polite, MD, MPP, associate professor of medicine, The University of Chicago, explained the 2 choices that practices have under QPP: MIPS and APMs. “There are no fully blessed oncology payment models yet, unless you choose the 2-sided risk model offered under the Oncology Care Model (OCM),” Polite said. This provided impetus for ASCO to develop its own APM, he explained.

In 2017, which is the first performance period, MIPS incorporates scores for quality, advancing care information (ACI), and improvement activities (IA), Polite said. “Cost, unfortunately, was not included in the 2017 MIPS program score,” Polite said, but will find a place in the 2018 scores.

Payment, he explained, will be based on where a practice falls along the range of low to high performers, compared with the National Median Composite Score. The 2019 scores are based on 2017 performance. A significant chunk (60%) of the score is driven by quality reporting, formerly known as the Physician Quality Reporting Score.

While the general oncology measures set includes 19 reportable measures that are a mix of process and outcome measures, reporting requirements mandate only 6 measures, at least 1 of which should be a outcome/high-priority measure, Polite said. Further, the practice is expected to report on at least 50% of patients eligible for each measure in 2017, which includes both Medicare and commercially insured patients.



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