MACRA Final Rule Year 3

Opt-In

Clinicians are eligible for the program if they meet all three thresholds: 1) providers and groups with more than $90,000 in Medicare Part B allowable charges, 2) more than 200 unique Medicare patients, 3) more than 200 covered professional services under the Physician Fee Schedule.

However, a clinician can opt-in to the program if they meet one or two of the thresholds. This, and the addition of new clinician types that fall under this program, could potentially help increase the number of clinicians who are participating. Because of the strict thresholds, and only 10% of urgent care patients being Medicare, there are few urgent care clinicians that are eligible. While there are those who fall on either side of the fence in regards to MACRA, the opt-in option would pave a way for clinicians to take part, while also being in the public eye with quality scores.

Quality Scores

This year will be the first that provider quality scores will be available for public viewing, which has been highly anticipated. These quality scores will allow for patients, employers and potential employers to see a score that represents the quality of care a clinician is providing. Because these scores will be permanent to a clinician, following them around from clinic to clinic, they will ultimately affect how a clinician is perceived and viewed by the public.

Measures for the Opioid Crisis

In addition to clinicians using an EHR/EMR that is 2015 Health-IT Edition Certified (CEHRT), there is more regulation in regards to the opioid crisis. Because of this growing epidemic, there are now optional measures that can be reported. Providers not only have to document that they have checked the prescription drug monitoring database, which is unique to each state, but a signed Opioid Treatment Agreement has to be electronically incorporated into the CEHRT.