MACRA: 4 Options for Physician Practices in 2017

October 3, 2016

The Medicare Access and CHIP Reauthorization Act (MACRA) intends to move the healthcare industry toward value-based and quality-based reimbursement. MACRA changes how CMS pays practices that provide care to Medicare beneficiaries, placing emphasis on quality care and improved patient outcomes. Physicians can take part via the Merit-based Incentive Payment System (MIPS), or an alternative payment model. In the short term physicians need to pay attention to the Merit-Based Incentive Payment System (MIPS).

MACRA initially conceived of MIPS as an intermediary step toward Alternative Payment Models (APMs), but the proposed rule on the new payment system appears to dump the vast majority of physician practices into MIPS. Although the details around reporting metrics under MIPS remain uncertain while the Centers for Medicare & Medicaid Services (CMS) works with physicians to refine a final rule, practices can still prepare based upon what we already know about the law:

  • MIPS scores clinicians under four categories, led by quality metrics that gauge performance based on clinical outcomes and account for half the overall score, according to the article. Advancing care information–an expanded, more flexible version of Meaningful Use–accounts for another quarter of the score, with the remainder tied to clinical practice improvement measures (15 percent) and resource use (10 percent).
  • Practices with high MIPS scores get bonus payments, while low-scoring practices get penalized. While some extra funds are available for bonuses, the system is predominately zero-sum, with penalties paying for most of the bonuses.

Bowing under industry pressure, the Centers for Medicare & Medicaid Services announced recently it would ease the implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), set to take effect on Jan. 1, 2017.

Physician practices will now have four options in order to pick their pace to comply with the new Medicare payment reform system according to the Administrator of CMS.

Option 1: As long as physician practices submit some data to the quality payment plan (including data from after Jan. 1, 2017), they will avoid a negative payment adjustment. This option will allow practices to test their systems and show CMS that it works and the practice is prepared for broader participation in 2018 and 2019.

Option 2: Submit data for part of the calendar year. Practices can still qualify for a small positive payment adjustment, even if the data for their first performance period begins after Jan. 1. This data would include quality measures, how your practice uses technology and quality improvement efforts.

Option 3: For practices that are already prepared for MACRA on Jan. 1, they can submit data for a full calendar year and could quality for a modest positive payment adjustment. CMS stated it has seen physician practices of all sizes successfully submit a full year’s quality data, and expect many will be ready to do so January 1.

Option 4: Participate in an advanced alternative payment model, such as Medicare Shared Savings Track 2 or 3 in 2017. Practices that receive enough Medicare payments or see enough Medicare patients through the model could qualify for a 5 percent incentive payment in 2019.

More details on all the options will be provided in the final rule, which will be released by Nov. 1 according to CMS.

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