REGULATORY REVIEW


MIPS replaces a few previous pro- grams under one roof, namely the Physician Quality Reporting Sys- tem, Meaningful Use and the Physi- cian Value-Based Payment Modifier. The goals of those programs live on in the four MIPS performance cat- egories: Quality, Cost, Improvement Activities, and Advancing Care Infor- mation (ACI). The four categories are weighted for importance in relation to a physician’s total score; Quality is worth 60 percent, Improvement Activ- ities are worth 15 percent, and ACI is worth 25 percent. For 2017 and poten- tially 2018, the cost category is not considered, though it will affect pay- ment adjustments at some point. ACI is the successor to CMS’ Meaning- ful Use program, which was designed to stimulate uptake of certified Elec- tronic Health Record (EHR) technol- ogy. Some physicians lack the face- to-face interaction and/or access to certified EHR technology (CEHRT), however, to make reporting under this performance category feasible. For example, there is no ASC-specific CEHRT. Thus, ASC physicians as well as those physicians that furnish 75 percent or more of their services in a hospital outpatient department (HOPD) are exempt from the ACI cat- egory. The 25 percent category score is re-distributed to the Quality perfor- mance category. Reporting in the various categories will translate to points on a scale of 0–100. For the first year, just 3 points will translate to a neutral adjustment (in 2019), and anything above will translate up to a maximum 4 percent positive adjustment. Non-participa- tion will equal a negative 4 percent 2019 adjustment. Scoring above 70 points is considered exceptional per- formance, and those physicians will be eligible for additional positive pay- ment adjustments pulled from a sepa- rate $500 million performance bonus pool. As previously mentioned, the maximum possible payment adjust-


ment will increase year to year, sta- bilizing at 9 percent, up or down, for 2022 and beyond. The new administration has made slight changes to the original rule in the proposed QPP rule released in June, some of which might ben- efit ASC physicians. In general, the administration has signaled a desire to slow down implementation of MACRA/QPP, giving physicians time and flexibility to ease into the struc- ture of the new system and get used to a new reporting framework. We have already noted the proposed expansion of MIPS exemptions to any physician under $90,000 in Medicare revenue and/or fewer than 200 unique patients. The 2018 proposed rule also outlined a widely expected proposal to allow solo practitioners and/or small physi- cian groups (10 or fewer clinicians) to combine into “virtual groups.” These groups would collectively report and be assessed under MIPS requirements, despite not sharing a geographic loca- tion or specialty. Finally, the 2018 proposed rule also eases the timeline for EHR uptake allowing physicians to continue using 2014-edition CEHRT. Currently, there


are only 74 products certified under 2015-edition CEHRT and none spe- cific for the ASC space. This issue will be a focus for ASCA going forward, as the lack of ASC-specific CEHRT ham- pers the ability of our physicians to be assessed accurately under the MIPS pay- ment adjustment formula. While ASCA works with stakeholders to develop cri- teria for an ASC-specific EHR certifi- cation we will continue to advocate for solutions such as excluding ASC patient encounters from penalty calculations and reweighting of MIPS composite scores that will reduce the potential of negative payment adjustments. There are many resources available to those wishing to learn more about MACRA, QPP or MIPS. For more information please visit qpp.cms.gov, where CMS has provided the NPI par- ticipation tool, fact sheets and other resources. General information about the Medicare program can be found at cms.gov/Medicare. Please also feel free to reach out to Alex Taira at ataira@ascassociation.org with ASC- specific MACRA questions.


Alex Taira is ASCA’s policy analyst. Write him at ataira@ascassociation.org.


ASC FOCUS SEPTEMBER 2017 |www.ascfocus.org 21


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