In my last column, I tried to explain the complicated math involved in calculating the potential financial impact of MACRA/MIPS on urgent care centers. I made the case for a significant return on investment for a typical urgent care with a typical mix of Medicare patients. Of course, all of the potential return depends on implementation of practical and efficient quality improvement programs that meet the measurement and reporting expectations outlined by the Centers for Medicare and Medicaid Services. So, in this column, we will explore the core categories in more detail, and I will share some practical examples of urgent care-relevant measures within each one.
The MIPS program has three core components that contribute to your overall bonus calculation:

  • Six Quality measures (60% of score)
  • Two Performance Improvement (PI) activities (15%)
  • Six Advancing Care Information (ACI) measures (25%)

Let’s look at the hundreds of Quality measures first. Not surprisingly, many are not very urgent care relevant. Among these, however, are others you can probably relate to:

  • Acute Otitis Externa (AOE): Avoidance of Systemic Antimicrobial Therapy
  • Adult Sinusitis: Appropriate Choice of Antibiotic
  • Appropriate Testing for Children with Pharyngitis
  • Documentation of Current Medications in the Medical Record
  • Use of Imaging Studies for Low Back Pain
  • Tobacco Use: Screening and Cessation Intervention
  • Appropriate Treatment for Children with Upper Respiratory Infection (URI)
  • Influenza Immunization

Next, let’s explore the Performance Improvement activities. There are about 90 of them. Beyond simply measuring data, these initiatives look to initiate systematic practice changes that improve performance. Here are some reasonably relevant examples to choose from:

  • Annual registration in the Prescription Drug Monitoring Program
  • Implementation of improvements that contribute to more timely communication of test results
  • Regularly assess the patient experience of care through surveys, advisory councils and/or other mechanisms
  • Use of decision support and standardized treatment protocols

Next, there’s Advancing Care Information (ACI). This category replaces the old “Meaningful Use” requirement and necessitates some cooperation from your electronic health record vendor. Examples here include:

  • Patient Education
  • Patient Portal
  • Medication Reconciliation
  • Health Information Exchange
  • E-Prescribing
  • Security Risk Analysis

The final Composite Performance Score used to determine your final payment incentive (or penalty) is calculated as follows:
(Quality Base + Quality High Performance Bonus) x 60% + (ACI Base + ACI Performance + ACI Bonus) x 25% + Improvement Activities x 15%.
Of course, eligible providers that choose not to participate at all will be given a Composite Performance Score of 0. Once composite scores are calculated on all eligible providers, a performance threshold is identified. Penalties and bonuses are based on whether you/your practice fall above or below the threshold.
Since I am certain that your head is spinning by now, here are a few take-home messages:

  1. If you participate at all in 2017, you are likely to receive a bonus payment, even if you submit limited data for a partial year.
  2. If you choose not to participate at all, you will almost certainly endure a penalty.
  3. If you put the work in and gather most, or all, of the data, you are likely to receive a bonus multiplier (“super bonus”).

While it is my hope that this summary helps simplify the MIPS program, I regret to inform you that more work is ahead if you actually want to participate. The goal from my last two columns was to demonstrate the potential revenue impact, demystify the reporting categories, and help you translate into the urgent care environment.
The rest is up to you. Good luck
Lee A. Resnick, MD, FAAFP
Editor-in-Chief, JUCM, The Journal of Urgent Care Medicine

Doing the MACRA’ena—Part II

Lee A. Resnick, MD, FAAFP

Chief Medical and Operating Officer at WellStreet Urgent Care, Assistant Clinical Professor at Case Western Reserve University, Editor-In-Chief for The Journal of Urgent Care Medicine
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