Emerald Health LLC - Electronic Referral System and EMR Software


How is MACRA and MIPS Affecting Radiologists?

With significant declines in reimbursements, rapidly changing payment models and interoperability initiatives all coming to a head under the Merit based Incentive Payment Systems (MIPS); one of two values-based reimbursement models under the Medicare and Access and CHIP Reauthorization Act of 2015 (MACRA). It is important to consider, “How is MACRA and MIPS affecting Radiologists?”

Radiologists must now look for new ways to better their health systems in order to further improve patient outcomes while decreasing cost.
1. How will radiologist lower the Risk of Potential Reimbursement Cuts with MIPS?
• They must determine if you are patient or non-patient facing, adopt clinical improvement activities, and explore the use of clinical data registries to help be successful in submitting quality data
• Services deemed patient facing need to submit 2 key measures for advancing care to satisfy the requirement
• Establish a mechanism to measure and analyze what clinical improvement activities you should be reporting
• Leverage a clinical data registry to avoid receiving a negative payment adjustment
o With claims-based reporting , there is no audit or review process, if the initial submission is inaccurate the individual or group will be penalized

2. How to improve patient outcomes and satisfaction while I decrease cost?
• Proactivity and better leveraging the data that already exists is just one of the tactics that can be adopted in 2017.
• With the right expertise level to help radiologist will be able to improve patient outcomes an lower cost
• Reduce referring doctors on the appropriate use of radiology services
• Hospitals will need to allow radiologists to access the necessary data for reporting, this could lead to cost savings and more efficient staffing.
If radiologists can be comfortable with Short-Term loses for Long-Term Gains, they will be able to transition smoothly. In the long run this will help radiologist to better navigate a health system’s ordering of radiology services. Groups will need to ensure they are participating in the new payment models to avoid finding that they are on the negative quality ratings list.

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