CMS reimbursement: MACRA’s impact in 2017

CMS reimbursement: MACRA’s impact in 2017

January 16, 2017
Dr. Amy Nguyen Howell
From the December 2016 issue of HealthCare Business News magazine
Hospitals, health systems and physician groups are in the process of deciding which of the two reimbursement paths they will take under the Medicare Access and CHIP Reauthorization Act (MACRA), which replaced the sustainable growth-rate formula for determining physician pay. The law will fundamentally change how Medicare pays physicians and other clinicians who participate in the Quality Payment Program (QPP).

With the January 2017 deadline fast approaching, MACRA has created a strong incentive for all U.S. physicians to move toward new care delivery strategies. Professional associations representing accountable physician organizations can provide resources to help physicians and physician organizations become successful under MACRA. This requires physicians to choose one of two paths to avoid a financial penalty: Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs), which both make up the QPP.

Merit-based Incentive Payment System (MIPS)

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Under MIPS, physicians get a percentage adjustment to Medicare Part B payment based on a four-part score designed to measure quality, cost and value of care. For the transition year of 2017, CMS lowered the cost performance category to 0 percent and gave clinicians four reporting options:

• Option one: Report under MIPS, but only one quality measure, one improvement activity or the required advancing care information measures to avoid a payment reduction. Physicians who choose this option will not be eligible for a bonus in 2019.

• Option two: Report under MIPS for less than the full year, but for at least a full 90- day period in 2017 on one quality measure, more than one improvement activity or more than the required advancing care information measures to avoid penalties. This could lead to eligibility for a small bonus in 2019.

• Option three: Report under MIPS for the full year in 2017 on quality improvement activities and advancing care information to be eligible for the maximum 4 percent bonus, as well as a potential exceptional performer bonus in 2019.

• Option four: Successfully participate in Advanced Alternative Payment Models (APMs). Physicians who choose this option will earn a 5 percent bonus incentive in 2019 and be exempt from MIPS payment adjustments. In short, physicians reporting at least some data in 2017 will not receive a payment reduction.

Risk means the ability to lose money in the case of subpar performance. The transition to MIPS may be fairly straightforward for groups that are already pursuing value-based payment methods and have reporting mechanisms in place. Further, the transition to APMs may be natural for physician groups that are already taking on substantial risk.

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