MIPS Quality Measures and Adopting MACRA

MACRA and MIPS Quality Measures go hand in hand. The medical Access and CHIP Reauthorization Act is also known as MACRA is the new rule on Medicare physician reimbursement that reforms the payment model through a quality-based program that includes penalties and bonuses which are tied to performance.

MACRA helps to stabilize the reimbursement and bonuses landscape in the healthcare system. This will improve patients’ access to information about physicians which is a good thing. However, MACRA requirements place tremendous reporting demands on health systems, hospitals, health practitioners, Doctors, Nurses etc.

These reporting demands are very complex and hard to comprehend. MACRA comprises of over 2,400 (two thousand four hundred) pages of regulations. This makes it hard for physicians, nurses and health practitioners to interpret and understand these regulations and their implications.

Failing to meet these requirements will have drastic implications on their organizations so understanding it is crucial. Like mentioned earlier MACRA places tremendous reporting demands on these health systems and clinicians and doctors making it an added burden and logistical/strategic requirement for the already overwhelmed clinicians. As complex as this is, health systems and clinicians need to stay on top of this and start preparing for MACRA now.

The best way to get ready for MACRA is to fulfill the Stage 2 Meaningful Use requirements and continue to work on always meeting the standards. Though most Health Systems believe physicians will benefit from MACRA and few health organizations and hospitals believe that MACRA will actually cost them money and expect to participate, they are not fully ready.

Hence, many health systems have hit the pause button on MACRA due to a combination of factors, including its complexity, the newness of the final rule, and uncertainty about whether the new Administration will make further changes. But those marching ahead are finding that compliance is likely to benefit their organization. The bottom line is that systems can choose which measures to report from their 2017 data, even if they haven’t finalized their MACRA compliance plan, and it’s likely worth their time.

Health Catalyst’s MACRA solution can help health organizations and clinicians understand MACRA’s requirements and navigate how to handle it efficiently without much hassle. Health Catalyst has provided a solution to the complex MACRA dealings. Health Catalyst has a lot of experience and can help health systems navigate and understand MACRA. They are determined to health organizations stay ahead of these frequently changing regulations in the industry and be efficient. Health Catalyst has provided MACRA Measures and Insights – an industry analysis tool built to help health systems and practitioners navigate the quality measures and the risks involved in not properly navigating them.

How to Prepare for MACRA Requirements

Below are some ways to prepare for the requirement of MACRA –

  1. Know your Status and keep track of it: The American Medical Association has a payment model evaluator that helps you know if you are qualified for or exempt from MIPS or Advanced AM tracks. You can also keep track of all MIPS and MACRA requirements to maximize your Medicare bonuses over time. These requirements will likely be updated on an annual basis so keeping track can help you meet and even surpass all requirements.
  2. Meet current quality reporting program measures: The sooner you start meeting the existing program measures successfully, the better prepared you’ll be to earn a higher payment bonus once MIPS starts. MIPS will combine and then streamline existing incentive programs and performance determined payment into one. So if you already have these existing rules met, you’ll be off to a good start.
  3. Target specific improvement areas: With this new reporting system, health organizations and practitioners might have to report on areas they don’t normally report on. Targeting specific areas to report on will help health organizations be proactive in gathering data in anticipation. This will make things easier and flow more smoothly.
  4. Prepare for CPIA: The center for Medicare and Medicaid is yet to release the specific requirements for certain categories such as clinical practice improvement activities but they will definitely consist of improving them so the more prepared health practitioners and organizations are the better.


It can be quite hard to keep up with all the rules and regulations of MACRA. A lot of providers, even when they have adopted MACRA or have started the process of adopting it, they still do not know or are not sure where they stand till the performance period is over. By this time, it is already too late and it does not allow for course correction if something goes wrong.

Not only does this not allow for any sort of course correction that could change the financial impact of the performance, but by the time a provider sees where the care gaps existed, it is often too late for them to impact patient care. Integrating data using electronic medical records (EMR) into a single repository, such as a data warehouse, and providing dashboards or portals for providers to be proactive, understand where to intervene, and setup improvements for individual success will enable the entire organization to proactively improve patient care and achieve a higher quality score.

The Performance Details feature of MACRA Measures & Insights can filter measures by data source, payor, provider, provider group, MACRA domain, cross-cutting area, and other categories to visualize your data in a proactive and responsive manner. Hopefully, this will be a useful solution to MACRA adopters.