New Healthcare Laws
MACRA What You Need to Know
With the Centers for Medicare and Medicaid Services’ (CMS) finalized rule last year for the Medicare Access and CHIP Reauthorization Act (MACRA), the landmark payment system for Medicare physician fees, qualifying physicians need to become familiar with its new rules and initialisms and make important decisions. MACRA, which replaces the sustainable growth formula, will pertain to healthcare providers who bill more than $30,000 a year for Medicare Part B services or provide care for at least 100 Medicare patients. For providers new to Medicare in 2017, participation is not required. Under the new rule, there will be some leniency for 2017 with “pick your pace options” to take part in the new MACRA Quality Payment program. The final rule includes two pathways for provider participation: the Merit-based Incentive Payment System, or MIPS, and the Advanced Alternative Payment Model, or APM. MIPS aims to align three currently independent programs — quality reporting (what physicians know now as PQRS), Advancing Care Information (now known as EHR Meaningful Use), and cost (now known as the value-based modifier) and adds a fourth component, Improvement Activities, aimed at promoting practice improvement and innovation. APMs typically offer shared savings, flexible payment bundles and other desirable features. There are two APM participation classifications — Advanced APMs, which have their own reporting requirements and are exempt from MIPS reporting, and MIPS APMs. CMS reportedly signaled it plans to create additional pathways for participating in the APM track, including a new accountable care organization Track 1+ model, Comprehensive Care for Joint Replacement and the Medicare Diabetes Prevention Program. CMS plans to add these programs in 2017 or 2018. CMS made adjustments to help small, independent practices participate. Besides the exemption for providers who fall below the $30,000 Medicare Part B charges or 100 Medicare patients to participate this year, CMS offers small practices and solo physicians the opportunity to join together in virtual groups and submit combined MIPS data. Except for those qualifying for the low-volume threshold, physicians who don’t report any performance data in 2017 will be subject to a -4% payment adjustment when the new adjustments take effect in 2019. Those who provide partial or full reporting may be eligible for positive payment adjustments. The final rule also allots $20 million a year for five years for training and educating physicians in practices of 15 or fewer and those who work in underserved areas.
For more information on MACRA, visit the American Medical Association page at:
https://goo.gl/CycoZt
JANUARY / FEBRUARY 2017 | THE BULLETIN | 13