MACRA is the Medicare Access & CHIP Reauthorization Act, also know colloquially as the ‘permanent doc fix’. Although MACRA is know for repealing the Sustainable Growth Rate (SGR) provisions that would have significantly cut physicians salaries (but was reversed every December), there are other provisions.
Although physicians may take comfort in avoiding the year end doc fix looming this year, more and more of Medicare physician’s payment will be tied to performance. As I reported back in April, the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Models are two ways that physician payments will change. The NCQA 2015 State of Health Care Quality report provides some additional details.
MIPS payments will be adjusted by 4 percent of clinicians’ total Medicare payments in 2019; adjustments increase to plus or minus 9 percent by 2021.MACRA’s second track, Alternative Payment Models (APM), may sound familiar. At the beginning of 2015 and before MACRA passed, HHS announced its intention to havealternative payment models covering 30 percent of Medicare fees by 2016 and 50 percent by 2018. At the same time, a coalition of private insurers, providers, purchasers and consumers announced a similar goal for 75 percent of payments by 2020.
The MIPS program rates providers along four dimensions: clinical quality, resource use, health IT meaningful use and clinical practice improvement activities (CPIA). Note that certain types of providers (e.g., patient centered medical homes (PCMH) and patient-centered specialty practices (PCSP) automatically qualify for CPIA status. NCQA expands.
Under MACRA, practices can propose APMs to CMS that accept two-sided financial risk and use electronic health records and quality measures.Clinicians in Medicare-approved APMs receive bonuses totaling 5 percent of their Medicare pay—substantial incentive to develop systems that have a greater ability to improve quality. Practices in Medicare PCMH demonstration programs shown to improve quality and reduce costs qualify as APMs and are eligible for the bonus. Other PCMH and PCSP practices are natural platforms for building additional APM proposals.
What other MACRA provisions are there besides MIPS, APM and the repeal of the SGR? MACRA also has a number of other quality improvement initiatives.
In 2016, Medicare is required to develop a plan to fill gaps in measurement and align measurement across payers…To help clinicians make the overdue transition to value-based pay, in 2018 Medicare is required to start giving clinicians information on care their patients receive from other providers and suppliers… MACRA also requires Medicare to give clinicians feedback on their performance compared with local and national benchmarks.
One thing is for certain, change is coming.