By Rhonda Quast
October 28, 2016
On Oct. 14, CMS released the final rule for the Medicare Access and CHIP Reauthorization Act (MACRA). The rule implements new value-based programs under MACRA, rewarding providers for improved, lower-cost, patient-centered care. It affects providers who bill Medicare more than $30,000 a year or provide care for at least 100 Medicare patients.
So what does this mean? The rule eliminates the sustainable growth formula. Eligible clinicians are to report to one of two Quality Payment Programs: Merit-Based Incentive Payment System (MIPS) or Alternative Payment Model (APM).
MIPS combines and sunsets three CMS programs: Meaningful Use, the Physician Quality Reporting System and the Value-Based Payment Modifier. Physicians will receive payment adjustments based on quality, cost, practice-based improvement activities and use of certified EHR technology. APM is designed for providers who're participating in specific value-based care models.
When does this start? Providers who are ready to start collecting performance data for a minimum of 90 continuous days can begin as early as Jan. 1, 2017, or as late as Oct. 2, 2017. No matter when providers begin collecting data, it's due to CMS by March 31, 2018. Data collected in the first performance year will determine payment adjustments beginning Jan. 1, 2019.
But why should I care? If you do nothing, you'll receive an automatic 4 percent negative payment adjustment. And under this program, the results will be on Medicare's Physician Compare webpage. Physician Compare is a CMS website consumers can access to help them make choices about health care services. Clinicians and health care organizations can access this site as well, and it can affect future referrals.
Physicians have four choices for reporting in 2017:
Don't worry, it's not as intimidating as it might seem.
For instance, if you've previously reported PQRS and Meaningful Use, you're already on the right track. This is similar.
If you haven't reported PQRS and Meaningful Use, here are some questions your organization should be asking to smoothly adopt the rule:
Doing nothing in 2017 is not the direction to take your organization. It will be a transitional year. Assess your organization, align your processes and accomplish your reporting goals.