Attendees at the first day of the American College of Cardiology (ACC) Cardiovascular Summit & Leadership Forum received “a big dose of MACRA,” said Howard T. Walpole, Jr. MD, MBA, course director and vice president of Clinical Effectiveness at Northeast Georgia Health System in Gainesville.

“We are in it already,” Walpole added, referring to the Jan. 1 launch of the first Quality Payment Program (QPP) performance period. The QPP, which was created by the Medicare Access and CHIP Reauthorization Act (MACRA), established the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models. These payment models were the subject of plenary and workshop sessions at the ACC’s conference in Orlando.

Ask the practice administrator

MACRA implementation may be underway, but it’s still mystifying for many in the cardiovascular community.

“In my group, they’re clueless; might as well be speaking Chinese,” muttered one cardiologist. Walpole echoed the sentiment from the podium hours later, after 29 percent of attendees using an audience-response tool indicated that their system or practice is not ready for MACRA and another 35 percent clicked, “I have no clue who is doing what to assure performance in MACRA.”

The need to answer that question, and promptly, was among many take-home points highlighted at the day’s MIPS sessions. For example, while delivering rapid-fire explanations of how MIPS works, Cathleen Biga, RN, MSN, course co-director and president/CEO of Cardiovascular Management of Illinois, urged attendees to write down “PECOS.”

Just asking their administrators about this acronym—which stands for “Provider Enrollment, Chain and Ownership System”—should be enough to prompt a check of how cardiologists are categorized in PECOS. By June, said Biga, cardiologists should ensure they are correctly identified as a cardiologist, electrophysiologist or interventional cardiologist—not an internist, she stressed—to confirm that their cost data will be evaluated against the performance benchmarks that best match the work they do. 

Talk to the EHR vendor

Cardiologists should work with their practice administrators on many of take-home tasks, but others may require conversations with their EHR vendor.

“[In MIPS], everything will come through your electronic system,” which means fields must be mapped correctly to ensure that cardiologists get credit for their quality activities, Biga explained.

Two things that MIPS-participating clinicians or practices must do: First, choose the six quality measures they will submit for the MIPS quality category and, second, understand where they stand against national benchmarks. (Bookmark the quality measures and the 2017 benchmarks.) Cardiologists also need to work with their administrators “to know exactly where in your workflow you’ll be pulling [the data for each] measure,” said Biga. “It is the most critical element in this whole quality game.”

This information should also be applied to improve EHR documentation pertinent to the quality measures. For example, if the EHR doesn’t have fields for noting medication intolerance, then the clinician’s scores on quality measures related to prescribing beta-blockers, for example, could suffer, said C. Michael Valentine, MD, ACC vice president and an interventional cardiologist at Centra Health in Lynchburg, VA.

The conversation about how the EHR is abstracting information might also need to include discussion of report cards. To have a chance at earning a bonus payment from the $500 million that the QPP has guaranteed for rewards in 2019, clinicians will need to tools to help with understanding the national benchmarks for the quality metrics they choose and with knowing how they are doing compared with other providers. “You have to have report cards,” said Biga. “You cannot function in a vacuum. You have to have your EMR spitting out reports.”

Access key reports & keep records

Cardiologists should take time to look themselves up on CMS.gov, Biga says. The Physician Compare reports allow individuals to check their scores on various measures, while Quality and Resource Use Reports (QRURs) include their readmission rates.

In case of an audit, practices should keep documentation “for everything you attest to,” she advised. “Take screen-shots, keep reports and file them for seven years.”

It’s also important to realize that MIPS goes beyond “just reporting” to successful reporting. “Whatever you report, Medicare will take. So do not report garbage data to them. If you have a measure that is poor, pull it [and use another],” she said.