American Association of Clinical Endocrinologists

MACRA and AACE: What it is, What we are doing, and Where we are going

What is MACRA?

MACRA, or the Medicare Access and CHIP Reauthorization Act of 2015 which replaces the Sustainable Growth Rate (SGR) formula, is designed to pay clinicians for the value and quality of care they provide. MIPS applies to Medicare Part B clinicians. CMS has renamed the reimbursement program to the Quality Payment Program or QPP. QPP will reform Medicare Part B payments across two tracks: Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs)

For more information on MACRA, please email MACRAinfo@aace.com



Quality Payment Program (QPP) divided into two paths:

MIPS

MIPS specifically replaces Physician Quality Reporting System(PQRS), the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

MIPS is divided into 4 categories:

  • Cost (0% of total score in year 1)
  • Quality (60% of total score in year 1)
  • Clinical Practice Improvement Activities (15% of total score in year 1)
  • Advancing Care Information (25% of total score in year 1)

Medicare Part B clinicians may be exempted from the payment adjustment under MIPS if they:

  • Are newly enrolled in Medicare;
  • Have less than or equal to $30,000 in Medicare charges and less than or equal to 100 Medicare patients; or
  • Are significantly participating in an Advanced Alternative Payment Model (APM).

APMs

Standards for Advanced Alternative Payment Models (APMs)

  • Require participants to bear a certain amount of financial risk
    • Total risk (maximum amount of losses possible under the Advanced APM) must be at least 4 percent of the APM spending target.
    • Marginal risk (the percent of spending above the APM benchmark (or target price for bundles) for which the Advanced APM Entity is responsible (i.e., sharing rate) must be at least 30 percent.
    • Minimum loss rate (the amount by which spending can exceed the APM benchmark (or bundle target price) before the Advanced APM Entity has responsibility for losses) must be no greater than 4 percent.
  • Base payments on quality measures comparable to those used in the MIPS quality performance category
  • Require participants to use Certified EHR technology

MACRA Implementation

The Centers for Medicare and Medicaid Services (CMS) announced that the final MACRA regulation will exempt physicians from any risk of penalties if they choose one of three distinct MIPS reporting options in 2017, in addition to the option of participating in an advanced APM:

  • Full-year reporting that begins on January 1;
  • Partial year reporting for a reduced number of days; and
  • A “test” option under which physicians can report minimal amounts of data.

Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose. Those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” those who choose partial year reporting will be eligible for a “small positive payment adjustment.” Physicians who choose the “test” option will not be subject to any payment adjustments. Qualified participants in advanced APMs will be eligible for 5 percent incentive payments in 2019.

AACE Activities

  • AACE formed the Task Force on the Implications of MACRA Law for Members in the Fall of 2015.
  • AACE held a MACRA Summit follow-up meeting in the Summer of 2016.
  • The MACRA Task Force has drafted a preliminary Advanced APM for diabetes care. Anticipates presenting to commercial insurance carriers in the of Winter 2016/Spring 2017.
  • The MACRA Task Force has begun work on Thyroid and Osteoporosis MIPS quality measures.
  • NEW! AACE WEBINAR: Are your ready for MACRA? CLICK HERE

Steps to Prepare Your Practice for MACRA

Are You Prepared?
Click here to learn more about MACRA and read these five easy steps to help prepare your practice for the new program.

Endocrine Toolkit for Success
Click here to access the Toolkit
AACE has created the Endocrine Toolkit for Success to assist you and your staff in day-to-day practice activities and the challenges you face during this time of tremendous change.

Endocrine Measures for MIPS Use

MEASURE NAME

NQF

QUALITY ID

NQS DOMAIN

Adult Kidney Disease: Blood Pressure Management

N/A

122

Effective Clinical Care

Adult Major Depressive Disorder (MDD): Coordination of Care of Patients with Specific Comorbid Conditions

N/A

325

Communication and Care Coordination

Adult Major Depressive Disorder (MDD): Suicide Risk Assessment

104

107

Effective Clinical Care

Appropriate Follow-up Imaging for Incidental Thyroid Nodules in Patients

N/A

406

Effective Clinical Care

Care Plan

326

47

Communication and Care Coordination

Communication with the Physician or Other Clinician Managing On-going Care Post-Fracture for Men and Women Aged 50 Years and Older

45

24

Communication and Care Coordination

Controlling High Blood Pressure

18

236

Effective Clinical Care

Coronary Artery Disease (CAD): Angiotensin-Converting Enzyme (ACE) Inhibitor or Angiotensin Receptor Blocker (ARB) Therapy - Diabetes or Left Ventricular Systolic Dysfunction (LVEF < 40%)

66

118

Effective Clinical Care

Diabetes Mellitus: Diabetic Foot and Ankle Care, Peripheral Neuropathy - Neurological Evaluation

417

126

Effective Clinical Care

Diabetes Mellitus: Diabetic Foot and Ankle Care, Ulcer Prevention - Evaluation of Footwear

416

127

Effective Clinical Care

Diabetes: Eye Exam

55

117

Effective Clinical Care

Diabetes: Foot Exam

56

163

Effective Clinical Care

Diabetes: Hemoglobin A1c (HbA1c) Poor Control (>9%)

59

1

Effective Clinical Care

Diabetes: Medical Attention for Nephropathy

62

119

Effective Clinical Care

Diabetic Retinopathy: Communication with the Physician Managing Ongoing Diabetes Care

89

19

Communication and Care Coordination

Documentation of Current Medications in the Medical Record

419

130

Patient Safety

Falls: Plan of Care

101

155

Communication and Care Coordination

Falls: Risk Assessment

101

154

Patient Safety

Falls: Screening for Future Fall Risk

101

318

Patient Safety

Functional Status Change for Patients with Foot or Ankle Impairments

424

219

Communication and Care Coordination

Hypertension: Improvement in Blood Pressure

N/A

373

Effective Clinical Care

Medication Reconciliation Post-Discharge

97

46

Communication and Care Coordination

Nuclear Medicine: Correlation with Existing Imaging Studies for All Patients Undergoing Bone Scintigraphy

N/A

147

Communication and Care Coordination

Osteoporosis Management in Women Who Had a Fracture

53

418

Effective Clinical Care

Patient-Centered Surgical Risk Assessment and Communication

N/A

358

Person and Caregiver-Centered Experience and Outcomes

Pneumococcal Vaccination Status for Older Adults

43

111

Community/Population Health

Preventive Care and Screening: Body Mass Index (BMI) Screening and Follow-Up Plan

421

128

Community/Population Health

Preventive Care and Screening: Influenza Immunization

41

110

Community/Population Health

Preventive Care and Screening: Screening for Clinical Depression and Follow-Up Plan

418

134

Community/Population Health

Preventive Care and Screening: Screening for High Blood Pressure and Follow-Up Documented

N/A

317

Community/Population Health

Preventive Care and Screening: Tobacco Use: Screening and Cessation Intervention

28

226

Community/Population Health

Preventive Care and Screening: Unhealthy Alcohol Use: Screening & Brief Counseling

2152

431

Community/Population Health

Screening for Osteoporosis for Women Aged 65-85 Years of Age

46

39

Effective Clinical Care

Statin Therapy for the Prevention and Treatment of Cardiovascular Disease

N/A

438

Effective Clinical Care

Weight Assessment and Counseling for Nutrition and Physical Activity for Children and Adolescents

24

239

Community/Population Health

Show Full Table

© Copyright 2018

AACE THE AMERICAN ASSOCIATION OF CLINICAL ENDOCRINOLOGISTS