Are you getting ready for the MACRA Transition?
2017 is considered as transition period for the newly enacted Medicare Access and CHIP Reauthorization Act (MACRA). Depending on performance, this new reform is about to either penalize or reward, or provide zero adjustment to providers’ reimbursement in the coming years.
Don’t miss MACRA Dates
Although it might outwardly appear that the financial impact of MACRA will be felt only after the beginning of 2019, it is better to understand that it may not be completely true. A maximum negative 4% adjustment penalty toward nonparticipation is possible to be slapped on those who happen to be eligible in 2017 but opt not to join an Advanced APM or submit data to MIPS. It is to be noted that for preventing penalty, it is essential to understand the eligibility needs and decide the best option for participation in 2017.
Goals of MACRA
The strategic goals for this new reform are listed below:
Improving practitioner experience by using easy to use tools
Enhancing engagement and outcomes using patient-centered MIPS and Advanced APM regulations
Promoting understanding about the program and maximizing participation
Increasing adoption and availability of Advanced APMs
Ensuring functional excellence in ongoing development and program implementation
Improving data sharing
According to the Centers for Medicare and Medicaid Services (CMS), nearly 500,000 practitioners are supposed to be eligible for participation in MIPS during the program’s first year. Performance metrics for the participants shall be submitted during March 2018. Negative or positive payment adjustments will be made on January 1, 2019.
MACRA – Mode of operation
Following two pathways are provided in this Quality Payment Program for rewarding delivery of high-quality patient care:
1. The Merit-Based Incentive Payment System (MIPS)
2. Advanced Alternative Payment Models (Advanced APMs)
MIPS Track
MIPS streamlines three of the previous pay-for-performance programs while adding another component for promoting the ongoing innovation and enhancement to clinical processes. These categories are listed below:
Quality
Resource Use
Clinical Practice Improvement Activities
Advancing Care Information
MIPS provides flexibility to clinicians for reporting measures and activities which demonstrate practice performance accurately.
Advanced APM Track
Clinicians will be able to earn favorable financial rewards under this track, by taking increased risk associated with patient outcomes. Practitioners who take part in Advanced APM can earn incentive payment bonus by following patient care improvement and taking additional risk. Advanced APM participation during 2017 enables 5% incentive payment bonus in 2019.
Choose your Track
Those who opt for MIPS may select any of the three tracks, namely, a ‘test run’, ‘participating category’, and ‘all in’. MIPS-eligible practitioners who prove to perform exceptionally will receive positive adjustment.
This may be the perfect option for those clinicians having certain portion of payments of patients channeled through an Advanced APM. Eligible practitioners will get 5% incentive payment annually from 2019 to 2024.
It is expected that more than 90% of MIPS-eligible practitioners will be receiving neutral or positive MIPS payment adjustment in the transition year. This includes 80% of clinicians in solo and small practices.
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The Impacts of MACRA and What Practices need to do
The full implementation of MACRA can be felt now. So much has happened after CMS released the 962 pages of proposal during 2015. Causing several confusions, anticipations, and anxieties, this complex law has certainly brought about a revolution in the medical industry – the final version with 2400 pages has been created by CMS after careful analysis of suggestions-making MACRA greatly flexible
Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) – its Direct Impacts
A. Simple Quality Reporting
o In the domain of quality payment program, the Merit –Based Incentive Payment Systems have replaced the three earlier programs, namely, Physician Quality Reporting System (PQRS), Meaningful Use (MU), and Value-based Payment Modifier (VBM). Moreover, there are other flexibilities such as reduced needs of measures to report on.
B. Sustainable Growth Rate (SGR)
o Physicians will be able to avoid heavy cuts that used to occur under the SGR regime. Repealing SGR was for facilitating the transition to the value-based reimbursement model
C. Increased opportunities and reduced penalties
o Previously, physicians were slapped with overlapping penalties. In MACRA, Clinical Practice Improvement Activities, a list having more than 90 activities needs to be performed by eligible clinicians – physicians get credit for efforts made – this moves away from the ‘all-or-nothing’ model
D. Reduced Negative Adjustment
o An eligible clinician will be able to avoid negative adjustments in this system. Eligible clinicians are allowed to operate at their own pace as per the new rule.
E. Efficient use of Technology
o Physicians are needed to efficiently implement supportive technologies. They have to record quality data, inculcate preventive care, and fill the gaps in care, care coordination, disease management, and several other activities that rely on advanced technology. More efficient use of EHRs and other systems are necessary
F. Better Reimbursement
o Payment received by physicians will increase by 0.5 percent till the year 2019.
G. Exceptional Performance will be rewarded
o Achieving a new threshold score of 3 helps you avoid negative adjustments.
CMS has made the first year, namely, 2017, the ‘transition year’; during this period, MACRA in a highly flexible version will be in place.
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