The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) brought significant changes to physician reimbursement rates. In a departure from the traditional one-size-fits-all approach, MACRA permits physicians to influence their reimbursement rates through a pay-for-performance system. MACRA emphasizes quality of care instead of increased medical services, and providers are rated based on the value offered, the quality of care and practitioners’ own level of accountability.
The Impact of MIPS on Reimbursement Rates
Under the new system, Medicare reimbursement rates are determined by a Merit-Based Incentive Payment System (MIPS) that rates each provider from 0 to 100. Strong scores result in a bonus payment, poor scores result in a penalty, and average scores result in no change to standard reimbursement rates.
Ratings are determined by individual scores in four categories:
- Quality — 50 percent
- Meaningful Use — 25 percent
- Clinical Practice Improvement — 15 percent
- Resource Use — 10 percent
As physicians improve their MIPS ratings, reimbursement rates increase.
Contributions From the MACRA Working Group
Leaders in the healthcare field and a large group of professional organizations saw an opportunity to enhance the MIPS program by incorporating elements of Continuing Medical Education (CME) in the scoring system. In July of 2016, many of the top CME organizations created the MACRA Working Group to explore possible roles for accredited CME in MIPS. As a result of this work, the Group made the following arguments supporting a relationship between CME and MIPS:
- CME promotes meaningful performance improvement and better patient outcomes through a commitment to lifelong learning.
- Permitting physicians to use CME towards MIPS goals allows them to benefit from the time they invest in these activities, increasing their incentive to participate in these activities.
- CME activities are a critical source of information on changing quality improvement requirements related to healthcare reform.
- There is no need to create new infrastructure for recording CME participation — this already exists through high-quality continuing medical education software.
In April 2017, The Centers for Medicare & Medicaid Services (CMS) met with the MACRA Working Group to discuss the Working Group’s recommendations, and the results were positive. CMS has requested additional research and information to move forward.
For delivering CME that may one day be counted for MIPS, consider working with EthosCE. EthosCE is the industry-leading, SCORM-compliant learning management system designed to automate and modernize the delivery of continuing education in the health professions. We work closely with leading medical association, academic centers, and health system to optimize their technology infrastructure and create an easy-to-use and intuitive environment for learners and CME administrators alike. For more information about our EthosCE, please contact us at 267-234-7401.