Physicians enjoy the extra attention that their patients receive from Your Nurse In Touch Care Managers. Studies show that patients enrolled in chronic care management programs are healthier, have better quality of life and have less probability of being hospitalized. That is why CMS has put so much effort into chronic care management and MACRA.
Beginning January 1, 2017 Centers for Medicare and Medicaid Services implemented the MACRA regulations for physician practices. Over 100,000 physicians participated in the creation of the MACRA regulations. When a physician’s practice has its patients enrolled in a program like Your Nurse In Touch for 90 continuous days, that practice will meet all of the MACRA and MIPS regulatory requirements for 2017. The same 90 day standard is applicable to 2018 as well. The MACRA regulation requirements increase each year of the phase in period. MACRA is the Medicare Access and CHIP Reauthorization Act with a new payment system that has incentives for healthcare practitioners for giving better care instead of more services. MACRA combines Value-based Payment Modifier, Physician Quality Reporting System and the Medical Electronic Health Record (meaningful use of CEHRT) incentive program into a single cohesive government program that avoids redundancies, called the Merit-based Incentive Payment System (MIPS).
The new MIPS reimbursement program pays the physician practice a Medicare Part B rate based upon a score that is derived from 4 categories of performance. The 4 categories of performance are:
- Meaningful use of a certified electronic health record
- Quality, using quality indicators
- Clinical practice improvement activities
- Resource use (Cost)
During the first year of the MIPS program, the score weights will favor quality. By 2019 there will be significantly more weight in the cost performance category, increasing from the current 10% of the score to 30%. If a physician practice does not meet the new MIPS regulations, the practice can be penalized by as much a 9%. If a physician practice meets all of the new MIPS regulations, the financial incentives reach 27% in 2022. The penalties and incentives are being phased in over the next several years.
The cost effectiveness of the chronic care management program appears to be the direct result of the patient being more in touch with the primary care physician. The care managers role is to identify triggers or problems so that they are communicated to the physician in a timely manner. This can reduce risk, because it allows for earlier intervention. The patient is referred to the primary care physician to address the newly discovered health issue. This has caused the physician practice to have a healthier clientele of patients, causing the average practice involved with a chronic care management program to increase their physician practice office visits. Medicare pays for the increased number of physician visits in addition to the chronic care management program and still saves hundreds of millions of dollars by keeping people healthier, thus avoiding expensive hospitalizations. A physician practice is permitted to meet the MACRA requirements through a third party. Your Nurse In Touch is a qualified third party provider that will work with your practice to meet all of the MACRA requirements. Your Nurse In Touch will provide the reports on practice patients through the use of CEHRT. As a basic function of chronic care management, Your Nurse In Touch will be meeting many quality indicators as part of the care management of the patients in their charge. A physician practice, working with Your Nurse In Touch will, on average, exceed the quality indicator and outcome measure requirements of MACRA. Chronic care management is better for the patients that are enrolled, it is better for the physician practice and the Federal Government has a more efficient healthcare system.