Insights: Article

Preparing to Participate in MACRA 2017

By   Rhonda Quast

October 28, 2016

On Oct. 14, CMS released the final rule for the Medicare Access and CHIP Reauthorization Act (MACRA)This link opens a PDF document.. 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 webpageThis link takes you to an external website.. 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:

  • No participation
    Result: An automatic 4 percent negative payment adjustment.
  • Submitting a minimum amount of data
    Result: A neutral payment adjustment and avoiding the 4 percent negative adjustment.
  • Submitting 90 days of data
    Result: A potential small positive payment adjustment or a neutral adjustment.
  • Submitting of a full year of data
    Result: Potential to earn a moderate positive payment adjustment.

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:

  1. Who are my eligible professionals that I'm billing for?
  2. What are the resources in my organization? Am I using a certified EHR technology?
  3. What does my community need? What's my strategic plan to meet these needs? What measures under MIPS support my strategic plan?
  4. Is everything being coded accurately, consistently and to the highest specificity? Does our documentation support our coding?
  5. Who are our key players we will identify to lead our MACRA readiness? How will we communicate this important initiative within our organization and keep our senior leadership informed of our progress?

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.