The first of a series of AdvancedMD webinars on MACRA, “Intro to MACRAnomics,” is scheduled for Tuesday, June 28, at 10 am MDT. Sign up today to be part of the conversation.
The Medicare Access and CHIP Reauthorization Act (MACRA) replaces Medicare reimbursement with a physician pay-for-performance program. What does that mean to you?
Under MACRA, you could face reductions or higher payments for performance. MACRA will also ease your transition from volume-based care, fee-for-service payment and quantity, to value-based care, bundled payment and quality.
MACRA replaces the baffling Sustainable Growth Rate (SGR) formula, which CMS created almost 20 years ago to reduce Medicare Part B spending. It also integrates diverse quality reporting programs, including Meaningful Use, Physician Quality Reporting System (PQRS) and Value-Based Payment Modifier (VBM) into a new program called the Merit-Based Incentive Payment System, or MIPS.
Beginning in 2017 MACRA will provide a .5 payment increase until 2019, when you can choose between two value-based payment models: MIPS or Alternative Payment Models (APMs). In the first payment year (2019) you could earn a maximum plus or minus four percent in payments, increasing to plus or minus 10 percent in 2022. You could also receive a bonus not to exceed 10 percent for exceptional performance within the first five years of MACRA.
MACRA will calculate a composite score based on your performance on four measures:
- Quality (50 percent)
- Cost or resource use (10 percent)
- Advancing care information or meaningful use (25 percent)
- Clinical practice improvement (15 percent)
Instead of choosing MIPS, you can select the APM value-based payment track. APM would reimburse you based on the value, not volume of Medicare services. If you receive a significant portion of your payments through APMs, you could get an exemption from MIPS and receive a lump payment of five percent for covered services. CMS aims to link 90 percent of payments to quality and 50 percent to APMs by 2019.
What should you do now? Consider the following three steps in moving toward MACRA:
Strategize and learn: No practice can afford to ignore MACRA’s Quality Payment Programs so develop a strategy for how you’ll approach it. CMS resources as well as AdvancedMD webinars and blog posts will help you master MACRA. Other programs will become available via the $10 million1 in MACRA grants that CMS has approved to help physicians with the transition.
Consider the opportunities: MACRA encourages physician network formation and resource sharing. Its unified payment and incentive program will pay physicians more for better care. Penalties will be less onerous than those under Meaningful Use. Finally, continuing demands for certified HIT technology can help reduce the financial burdens of small practices.
Reflect on practice performance: Take a closer look at how you perform on MACRA’s four performance measures: quality, cost or resource use, advancing care information and clinical practice improvement. Among the specifics to consider:
- Quality: Which six out of nine quality measures would you choose?
- Cost: How well do you manage resources in treating similar care episodes?
- Care information: How effectively do you promote interoperability and security in e-prescribing, for example?
- Clinical practice improvement: How do you deliver care via enhanced patient access and care coordination?
- CMS documents: Where do your stand on Quality Resource Use Reports (QRURs)?
Want to learn more about ways and means to thrive under MACRA? Join AdvancedMD educational webinar series exploring MACRA. Over the course of seven webinars, you will learn everything about MACRA including what it is, different categories within MACRA, four sections of MIPS and APMs, and steps to take to make MACRA work for you. Register for the webinar.