MACRA: Addressing the Transition

Editor's Notes

1. Replace all of the different “patchwork programs”; MACRA repeals the Sustainable Growth Rate (SGR) Formula; Combines PQRS, VBM and MU into one measure; It adds Clinical practice improvement activities 2. Ties 80 percent of traditional Medicare payments to quality by 2016 and 90 percent by 2018. 3. MACRA’s value-based payment programs will be based on two new reimbursement structures: MIPS & APM 4. Performance data from 2017 will determine payment in 2019 5. It’s making significant changes within a healthcare provider’s processes and workflows and changing how Medicare approaches their payments. 6. MACRA is an attempt to simplify reporting, remove confusion around reporting; BUT it mandates reporting now
2. From a financial standpoint, 2 paths have different impact MIPS - 2019: +/- 4% going up to 2022: +/- 9% APM - 5% annual lump-sum bonuses From a clinical standpoint, Quality is 50% of your focus in overall score; Since it’s a significant portion, measuring and improving quality is vital to the physicians. Focus areas are Patient safety Patient Engagement Patient Experience Care coordination outside 4 walls Should have processes and tools needed to baseline your performance and jumpstart the MACRA journey. In 2017, understand and strengthen quality benchmarks MACRA gives physicians the flexibility to report on measures and performance that best fit them; and you should start looking finding your niche and start tracking and improving on those measures
3. Yes, Hospitals employ physicians Facility charge Clinician charge impacted
4. 1. All providers —with a few exceptions—will most likely report through MIPS in the first year of the program. That data will then be used by CMS to determine which providers met the requirements for the APM track. Providers are not locked into their choice—they can switch between MIPS and APM annually. 2. A physician who selects MIPS is staying within the familiar fee-for-service territory but the payments will be value-based with CMS judging value based on a new set of metrics. Those who deliver the best "value" will reap the greatest rewards (payment). But the "fees" will go up or down based on those new reporting metrics. 3. Broadly speaking, APMs are payment models such as accountable care organizations (ACOs) and patient-centered medical homes (PCMHs). The MACRA rule says APMs must meet three requirements to qualify: participants must use certified EHR technology; the APM must pay clinicians based on quality measures comparable to those used in the quality performance category of MIPS; and be either an accredited PCMH or participate in risk-sharing as part of an ACO-like arrangement or, as the rule puts it, “bear more than a nominal amount of risk for monetary loses.” The proposed list of models that would qualify for primary care physicians include: the new Comprehensive Primary Care Plus program, Medicare Shared Savings Program, or next generation ACOs. CMS says it will update the list of qualified APMs annually.
5. By NOT following MACRA, you WILL be penalized So NO, there are no alternatives to MACRA You should either choose between MIPS or APM $10M for 200 bed hospital..
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