A panel discussion, titled, "Holy MACRA! How to Survive and Thrive in the New Era of MACRA, MIPS and APMs," was presented on Sunday at the 2017 American College of Rheumatology (ACR) Annual Meeting in San Diego, California.
A panel discussion, titled, "Holy MACRA! How to Survive and Thrive in the New Era of MACRA, MIPS and APMs," was presented on Sunday at the 2017 American College of Rheumatology’s (ACR) Annual Meeting in San Diego, California. The session provided practice managers with key information about keeping pace with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), and also provided ACR with a prime opportunity to reveal the initial draft of its new, Medicare Access and CHIP Reauthorization Act-, or MACRA, compliant alternative payment model (APM) for rheumatoid arthritis (RA).
Challenges With MIPS
The panel began with moderator Angus Worthing, MD, FACR, FACP, providing an overview of the challenges that the merit-based incentive payment system (MIPS) poses for clinicians. Under the 2017 structure for MIPS, the categories of quality (60%), resource use (0%), clinical practice improvement activities (15%), and advancing care information (25%) are combined to create a composite score that determines a practice’s annual adjustment from CMS.
Worthing pointed out 3 key downsides to MIPS:
Succeeding With MACRA
Ed Herzig MD, FACP, MACR, gave practical advice to rheumatologists looking ahead to the first adjustment period in 2019. Activities that practices may already be undertaking can be reported as quality performance activities, and Herzig encouraged practitioners to report activities such as documenting current medications in patient records, conducting osteoporosis management in women with fractures, conducting glucocorticoid management in patients with RA, and evaluating RA functional status.
Herzig also offered global tips for success with MACRA:
An APM for RA
Last to speak was Kwas Huston, MD, who unveiled ACR’s draft of a new APM for the treatment of patients with RA. The organization hopes to eventually expand the model to other diseases if it is approved by the Physician-Focused Payment Model Technical Advisory Committee (PTAC) and CMS.
The APM creates a standard approach to RA treatment based on ACR guidelines, requires the use of methotrexate and disease-modifying anti-rheumatic drugs (DMARDs) before the use of biologics, specifies the frequency and type of monitoring for patients, and will be updated regularly by ACR. A 75% adherence rate for reporting will, said Huston, provide flexibility to provide care to patients whose circumstances require deviation from the standard approach.
The model recognizes 4 phases of RA care:
For accountability, clinicians must meet face-to-face with patients at least once every 6 months, document disease activity using a validated scale, maintain a written RA treatment plan consistent with the ACR pathway, follow-up within 2 weeks of a medication change, complete a functional assessment, conduct a tuberculosis screening, and create a steroid plan.
Practitioners who follow the treatment pathway 75% of the time will be exempt from penalties. Those who fall short of 75% compliance will be subject to adjustments from —2% to –8%.
The pathway, said Huston, provides adequate payment for high-value services, avoids MIPS penalties, reduces documentation, keeps physicians from being responsible for the high cost of drugs, and gives clinicians more control over performance measures.
The Push for Fair Pricing and Reform in Pharmacy Benefit Management
April 3rd 2025Amid growing legislative pressures and industry debates, pharmacy benefit managers (PBMs) are exploring new strategies to enhance transparency, reduce patient costs, and navigate the evolving healthcare landscape.
Read More
The Importance of Examining and Preventing Atrial Fibrillation
August 29th 2023At this year’s American Society for Preventive Cardiology Congress on CVD Prevention, Emelia J. Benjamin, MD, ScM, delivered the Honorary Fellow Award Lecture, “The Imperative to Focus on the Prevention of Atrial Fibrillation,” as the recipient of this year’s Honorary Fellow of the American Society for Preventive Cardiology award.
Listen
Using AI-Driven Strategies to Optimize Specialty Drug Costs, Manage Polypharmacy
April 2nd 2025As health care costs continue to rise, artificial intelligence (AI)-driven solutions are emerging as a powerful tool for managing specialty drug spending and polypharmacy risks, as showcased in recent research presented at the Academy of Managed Care Pharmacy 2025 conference.
Read More
Promoting Equity in Public Health: Policy, Investment, and Community Engagement Solutions
June 28th 2022On this episode of Managed Care Cast, we speak with Georges C. Benjamin, MD, executive director of the American Public Health Association, on the core takeaways of his keynote session at AHIP 2022 on public health policy and other solutions to promote equitable health and well-being.
Listen
How Recent Federal Policy Changes Are Shaping Managed Care Pharmacy
April 2nd 2025Federal legislative and regulatory changes are reshaping pharmacy practice, with key challenges in government funding, pharmacy benefit manager reform, and health care policy shifts—topics explored by experts at the Academy of Managed Care Pharmacy's annual meeting.
Read More
The IRA’s Unintended Consequences for Drug Pricing and Coverage
April 2nd 2025The Inflation Reduction Act (IRA) may be restricting Medicare Part D formularies, increasing patient costs, and stifling pharmaceutical innovation, experts warned at the Academy of Managed Care Pharmacy 2025 annual meeting.
Read More