By now you’ve probably heard of the Medicare Access and CHIP Reauthorization Act (MACRA) legislation. It has been getting attention lately, especially after its long-anticipated (and nearly 2,400-page) final ruling came on October 14, 2016. Perhaps you’ve been pushing MACRA to the back of your mind, or you are lumping MACRA with the other acronyms of the healthcare industry. Unfortunately, MACRA is not to be ignored because, if you do, you could lose 4 to 9 percent of your Medicare revenue between 2019 and 2022, according to The Centers for Medicare and Medicaid Services (CMS).
MACRA, now called the Quality Payment Program (QPP), changes Medicare physician payment by:
- Repealing the Sustainable Growth Rate (SGR) methodology for determining updates to the Medicare physician fee schedule
- Establishing annual positive or flat fee updates for 10 years and instituting a 2-track fee update beginning in 2019
- Establishing the Merit-based Incentive Payment System (MIPS), which consolidates existing Medicare quality programs
- Establishing a pathway for physicians to participate in an Alternative Payment Model (APM)
The QPP promotes quality by providing annual financial incentives for high performance, in lieu of the annual pay cuts that were produced by the SGR formula. It shifts from a fee-for-service model based on volume to a fee-for-value model, the QPP. It’s designed for clinicians to deliver quality care to their patients.
With the final ruling now issued, the first year’s performance is slated to begin on January 1, 2017. Next year’s report will impact payments in 2019, which means it’s time to get ready, now.
Distinguishing between the 2 QPP tracks
Under the QPP there are 2 payment options to choose from:
- MIPS – The Merit-Based Incentive Payment System is the default track which combines 3 currently independent programs into one. These include Meaningful Use (MU), Physician Quality Reporting System (PQRS) and the value modifier. This will initially encompass most physicians, and provides them the flexibility to choose the activities and measures that are most meaningful to their practices to demonstrate performance. MIPS does not apply to hospitals or facilities.
- APM – The Alternative Payment Model is for physicians on the cutting edge of population health management who are already working to lower costs and improve quality. Those who choose this track are exempt from MIPS and should receive more favorable financial incentives, such as a fee schedule that improves at a faster rate. The final ruling broadened opportunities for physicians to participate in alternative models.
It is expected that most practices will report under MIPS in 2017, unless they are new to Medicare or bill very low Medicare volume. The CMS will determine which clinicians qualify for APM status. Only a small number of groups will initially meet APM requirements; but over time, more APMs will become available.
What you can do
It’s easy to brush the QPP aside if you’re not sure which track to follow, but you shouldn’t. There are 5 things you can be doing to make sure that you are prepared come January 1, 2017:
- Choose an option under MIPS. Although flexible measures during 2017 allow for additional prep-time for some, the urgency remains high to understand MIPS requirements, set a strategy for reporting, and improve performance across all categories. (See sidebar.)
- Start reporting. If you haven’t reported data on quality measures through PQRS or as part of MU, get started now. Negative payment adjustments for not reporting or for low quality may impact you this year.
- Check your progress. If you submitted quality data during the last calendar year, you should access your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement.
- Implement certified EHR technology. A certified electronic health record (EHR) can help providers fulfill reporting requirements with much less effort. EHRs can provide summaries of quality measure progress and can generate the documentation required for attestation. In fact, the government says it’s moving to align the measurement of certified EHR technology with the improvement activities. Be sure to select a provider that has a high attestation rate for MU.
- Stay informed. Monitor the CMS MACRA website for additional updates.
Don’t get too caught up in acronyms, and don’t find yourself unprepared. When it comes to MACRA, your Quest Diagnostics team is here to not only guide you, but to help you succeed during this transition. Just give us a call at 1.888.835.3409.