CMS last month unveiled the details of its Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which replaces the much-maligned sustainable Merit-based Incentive Payment System (MIPS) growth rate (SGR) physician fee schedule with the Merit-based Incentive Payment System (MIPS) for eligible clinicians and groups.
MIPS could result in higher reimbursements. As the American Association of Family Practice reports, $20 million will be allocated annually to provide technical assistance via Quality Improvement Organizations (QIOs) and Regional Extension Centers (RECs) to practices with 15 or fewer eligible professionals participating in an alternative payment model (APM) or MIPS. But “could” is the operative word. As proposed, MACRA’s incentive payment system is overly complex and could drive clinicians out of the industry, wrote Beth Israel Deaconess Medical Center CIO John Halamka.
The timing is worrisome as well. MACRA consolidates the Meaningful Use, Value Modifier and Physician Quality Reporting System programs, but the new program is vastly different. The rule implementing MIPS will be published by November, and the first performance period would start in January 2017. Providers, vendors, and CMS will have to make significant changes before then. Practices and organizations will have to understand composite performance scores and endure payment adjustments, sliding scales, and more performance thresholds.
When MACRA passed last year, lawmakers indicated Medicare should promote flexibility and innovation in the delivery of care, with the goal of improving quality and offering better outcomes for patients. However, at a May 11 hearing before the House Ways and Means Committee to discuss the MACRA rule, Committee members declared MACRA must not hurt solo physicians and those in small practices. CMS’s own data suggests 87% of solo practices will see negative adjustments in payments. However, CMS Acting Administrator Andrew Slavitt has said those numbers are based on 2014 data, when most small and solo practices were not reporting quality data, and will be updated in the final rule.
This is a pivotal moment in payment reform. Under the Quality Payment Program, providers will be accountable for not only reporting, but also their performance on a broad range of behaviors. The incentives will push practices toward less risk, and with the payments at stake for MIPS participants, the development of care management and quality reporting strategies is vital. Given the complexity of the new payment system and its potential impact on patients, there is a tremendous amount of work to be done before the first performance year begins in January.
The proposals in MACRA are not a done deal, by any means, and CMS is taking comments from now through June 27 at 11:59 p.m. As a heathcare professional, your time is scarce as well as valuable, but consider taking a few minutes to weigh in on MIPS and APM.

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Last Updated on April 23, 2016