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Meaningful Use and MACRA

Posted by Jessica Langley on March 2016

Confusion Around “Meaningful Use” Lifecycle and MACRA – Will it Affect Medical Assistants?

A recent statement by a Centers for Medicare and Medicaid Services (CMS) representative that “Meaningful Use” was going to end in 2016 has been widely published and often misconstrued, particularly with respect to its impact on credentialed medical assistants.

While it is true that the CMS will be switching incentive programs for practice-based healthcare providers, the new incentive programs will continue to measure EHR meaningful use. Moreover, there has been no indication from the CMS that it intends to change its rule allowing EHR orders entered by credentialed medical assistants to count towards incentive calculations.

MACRA: The New Meaningful Use

In 2016, new incentive programs for physicians (hospitals will still be under the old program, perhaps for 2 more years) are scheduled to go into effect. The Medicare Access and CHIP Reauthorization Act (MACRA), passed in April 2015, shifts Medicare compensation from a fee-for-service approach to a pay-for-performance (PFP) approach, also known as pay-for-value, in most outpatient healthcare settings.

Under MACRA, physician practices must choose between two PFP models. The alternative payment model (APM), which is more advanced, is for physicians participating in patient-centered medical homes, accountable care organizations, and Medicare shared-savings programs. The other model is the Merit-Based Incentive Payment System (MIPS). It will incorporate and align EHR meaningful use and two other incentive programs — the Physician Quality Reporting System and the Value-Based Payment Modifier. Medicare will increase or decrease a physician's fee-for-service reimbursement in MIPS according to his or her quality of care, use of medical resources, clinical practice improvement, and meaningful use of EHRs (source: Medscape.com, membership required). 

MACRA incentives depend on a composite performance score across the following categories:

  • Quality:  Marks for quality reporting and quality care;
  • Resource use: Movement towards top-of-license resource use;
  • Clinical Practice Improvement: Such as better patient access, population management, care coordination and patient safety assessments; and
  • Meaningful Use: The practice is a meaningful EHR user.

While the last of these categories expressly references meaningful use, we believe that each of the other categories reinforce the need to utilize credentialed medical assistants to increase performance and enhance patient care. 

CMS will issue MACRA regulations and further define these categories later this year and, although possible, we do not anticipate that CMS will change its stance on the role of credentialed medical assistants. It is clear, however, that the focus remains on quality. The philosophy around team-based care and the growth of Patient Centered Medical Homes, along with the need for chronic care coordination, supports NHA’s belief that the healthcare industry will continue to focus on ensuring that physicians and others work to the top of their licenses, allowing frontline allied health staff, and particularly certified clinical medical assistants, to play active roles in ensuring and  providing quality patient care.

This leaves opportunity not only for national certification for medical assistants but also advanced training and career ladder development within the profession. This, in turn, will lead to increased recognition and reputation for the role that the medical assistant plays in today’s care models.

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