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Dietitians at Home Helps Physicians Manage the TRansition to Value-based Care

Value-based care focuses on rewarding physicians with incentive-based payments for the quality of care they deliver through Medicare. Dietitians at Home helps physicians manage the transition to these new programs, such as MACRA and MIPS, by helping physicians meet rigorous quality standards for patients with diabetes.

Value-based programs will affect how physicians are paid as soon as 2019, and any physician not already using an EMR will automatically receive a 4% reduction in payments.

Four years of undergrad. Four years of medical school. Three to seven years of residency training, and that doesn’t include a specialty. Becoming a physician is hard work.

 Becoming a physician is hard work. 

And as if hundreds of thousands of dollars and more than a decade of your life weren’t enough, once you become a doctor, there are still countless complications, many of which have nothing to do with patients at all. Same goes for physician’s assistants, nurse practitioners, and clinical nurse specialists – years of training and dedication to reach a point where you can help people… and deal with a mountain of paperwork and policies to get the job done. Dietitians at Home knows what a headache it can be, that’s why we work with healthcare providers to help make your job easier, so you can spend more time with your patients and less time dealing with red tape.

MACRA: A Challenging Evolution into Modern Medicare

On April 16th 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which, among other things, permanently adjusted the Medicare physician payment formula and created a new framework to reward physicians for providing higher quality care.

Implementation began on January 1st and, as with any major system overhaul, has come with its own set of challenges (just ask Apple how things are going with the iPhone 8). According to sources including Health Affairs (an industry publication that analyzes policy and issues affecting health care), “the main problem with MACRA implementation at this point is that the legislation assumed a health care infrastructure—in terms of meaningful performance measures, access to relevant data, and viable APMs—that does not yet exist.”

So how do you navigate the new system in a way that aligns your goals with patient goals and manages many of the more challenging aspects of the change? Well let’s first take a quick look at how MACRA works.

Dietitians at Home


Making Sense of Medicare Quality Measures


At its heart, MACRA provides a new framework for reimbursing clinicians who successfully demonstrate value over volume in patient care – a great thing for everyone.

MACRA includes two payment tracks:

  1. Merit-based Incentive Payment System (MIPS)
    A program that measures eligible professionals on quality, resource use, clinical practice improvement, and meaningful use of certified electronic health record (EHR) technology.
  2. Alternative Payment Models (APMs)
    New ways to get paid for care provided to Medicare beneficiaries, including accountable care organizations, patient-centered medical homes, and bundled payment models.

Together, these payment methods are referred to as the Quality Payment Program (QPP) – just think of it as the way health care practitioners are paid for providing good quality care.

Just think of it as the way healthcare practitioners are paid for providing good quality care.

*Side note: MACRA includes a heap of confusing acronyms and it can be tough to keep them all straight. We’ve tried to explain the relevant ones here, but if you’re still confused, this glossary from the American Medical Association comes in pretty handy.

Since the new payment system is based on quality, it follows that Medicare needs a way to track said quality. In fact, MACRA combined three existing quality-reporting programs into one new system under the Merit-based Incentive Payment System (MIPS) and today’s challenge is learning how to work within it to demonstrate quality care.

The Cost of Tracking Care - Who Must Report

Physicians and healthcare staff currently spend, on average, 785.2 hours ($40,069 per physician) each year, tracking and reporting quality measures for Medicare, Medicaid, and private health insurers. That’s the equivalent of 24 hours a day, 7 days a week, for more than an entire month! It’s an enormous administrative and financial burden and takes valuable time and resources away from patients. Surely there are much better ways to spend your time (patient care, personal time, time with family and friends all come to mind). 

Under MIPS in the Quality Payment Program, physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who:

  • bill Medicare more than $30,000 in Part B allowed charges a year, and
  • provide care for more than 100 Medicare patients a year must report under the program and will receive a performance-based payment adjustment.

The MIPS payment adjustment is based on the quality reporting data submitted. Better quality will mean a higher adjustment.

How is Quality Scored?

The final MIPS score is made up of scores from four categories:

  • Quality, based on the Physician Quality Reporting System (PQRS)
  • Resource use, based on the Value-based Payment Modifier (VBPM)
  • Advancing Care Information (ACI), based on meaningful use (MU); and
  • Clinical practice improvement activities (IA), a new performance category.

These four scores are combined to establish a final score (0-100) that is compared against a performance threshold and all MIPS-eligible clinicians.

How Dietitians at Home Is Helping to Ease the Burden

At Dietitians at Home, we work with physicians to help meet MIPS requirements set out by Medicare.

At Dietitians at Home, we work with physicians to help you meet the MIPS and MACRA requirements set out by Medicare. Our innovative evidence-based programs can be incorporated into your plan of care to help you meet MIPS and MACRA requirements. In addition, we provide results-based, patient-focused preventative care. 

We also work as a trusted partner to provide insight into industry developments and policy changes, detailed reporting, ongoing collaboration, and communication on patient care, specializing in population health management. We offer detailed clinical measures, data, and metrics on all our patients. We help coordinate care and facilitate communication among health care providers. We aim to reduce hospital readmissions. All of this means a better MIPS score, less time stressing over paperwork, and more time doing the work you love.

At our core, we care about delivering quality care to patients, a goal that’s intrinsically linked with the goal of MACRA, and, no doubt, your own.

Addition Resources on MACRA and MIPS

Dietitians at Home works with physicians and other healthcare practitioners to bring diabetes-related treatment and services to underserved patients and communities in the Chicagoland area. For more information visit