What does the final rule for MACRA’s Quality Payment Program mean for you, in ophthalmic medicine? Most importantly, it means the transition from fee-for-service to fee-for-value is solidly here. Request a FREE MACRA evaluation today.

Making sense of two payment pathways

The ruling establishes a new Quality Payment Program (QPP), which consists of two payment pathways – Advanced Alternative Payment models (APMs) and the Merit-based Incentive Payment System (MIPS).

Most providers in ophthalmic medicine will not be participating in an APM in the initial year or two, so for now let’s focus on MIPS.

MIPS 101

MIPS consolidates three existing value and quality programs: Meaningful Use, PQRS, and the Value-based Modifier program. (This change applies to Medicare Part B only.) Under MIPS, you’ll earn a MIPS Composite Performance score based on the following factors:

  • Quality Reporting
  • Resource use (cost)
  • Advancing care information (Meaningful Use)
  • Clinical practice improvement activities 

And here’s some good news – any preparations you make to comply with the MIPS program will fully transfer to an advanced APM, if you make that transition in future years.

How to participate in Quality Reporting

Now, let’s focus on Quality Reporting, which for the initial reporting year (2017) makes up the largest component of the MIPS scoring at 60%. Quality Reporting is based on PQRS with some modified rules. You can report on up to six quality measures, with at least one being an outcome measure. You must do this for a minimum of 90 days. You get bonus points for reporting electronically.

What measures to support?

To create and submit your reports, you’ll first need to figure out what measures to support. Check out this chart to help answer that question.








How NextGen Healthcare can help

Reporting electronically is easy (and on the house) for NextGen Healthcare clients using NextGen® Health Quality Measures.  In addition, our NextGen Healthcare Clinical Registry Service allows you to electronically submit to over a dozen QCDR-compliant specialty registries and there is no charge for the connection. Plus, NextGen Healthcare ophthalmic solutions support nine outcome measures, nine effective clinical measures, two patient safety measures, and more.  New for this year we are adding PQRS 141. This lowers your Intraocular Pressure by 15%.  We also support two cross-cutting measures, one for tobacco use screening and counseling and one for documenting current medications.

Stay up to date

Hopefully, your head isn’t spinning. But if it is, we have more resources and experts ready to help you succeed.

  • Visit our dedicated MACRA page, with up-to-the-minute information you need to guide you through the transition.
  • Read ongoing MACRA-related posts on our blog.