Explainer

7 things you might not know about MACRA, but should

The new Medicare physician payment system is set to start Jan. 1, 2017. Are you ready?

The start date of MACRA, the new Medicare physician payment system, is coming up fast; it’s slated to go into effect Jan. 1, 2017. The Centers for Medicare and Medicaid Services (CMS) has just announced it will provide significant flexibility to clinicians for MACRA reporting in 2017. A final rule will be issued by the end of October laying out MACRA’s complete timeline and details. Based on the latest updates, here’s a look at what physicians need to know to navigate the new payment system successfully.

1. MACRA rewards DOs for the way they already practice. “The U.S. health care system is moving toward aligning more closely with the osteopathic emphasis on prevention and whole-person care,” says Laura Wooster, MPH, the AOA’s vice president of public policy. “It’s not going to happen all at once, and there may be a few bumps along the way, but ultimately, I think DOs will find this new system really aligns with how they practice.”

2. You’ll choose between two pathways: Under MACRA, physicians can either select the merit-based incentive payment system (MIPS) or an advanced alternative payment model (APM). MIPS merges three existing quality programs and adds one new reporting area, clinical quality improvement activities. Both pathways reward high-quality, coordinated care delivered at reasonable cost, in contrast with the fee-for-service payment model Medicare used in the past.

3. In 2017, MACRA will offer flexible reporting paths for an easier start. If you participate in MACRA at all in 2017, you’ll avoid all penalties and may be eligible for bonuses depending on your performance and the pathway you choose. In the MIPS, physicians have three options: Reporting all data for all of 2017, reporting all data for part of the year, or simply testing the program by submitting some data at any time in the year. If you participate in an advanced APM, you won’t need to submit MIPS data and you may qualify for an incentive bonus if you receive enough Medicare payments or see enough Medicare patients through the APM.

4. Get a head start on MIPS by reviewing how your practice fared in previous CMS quality reporting programs such as the physician quality reporting system, value-based payment modifier and meaningful use of electronic health records. Any improvements you can make in your data collection or reporting processes will benefit you in the MIPS. Also, take advantage of the new clinical quality improvement activities category, which rewards physicians for practice enhancements such as extended office hours.

5. Study up on advanced APMs if you’re thinking of transitioning to one in the future. Understand the initial six MACRA-approved options and how the move could affect your business model. “One of the issues to consider is that advanced APMs do require two-sided risk,” explains Ray Quintero, the AOA’s senior vice president of public policy. “That means you could potentially lose money, but your practice could also really gain money.”

6. Patient-centered medical homes (PCMHs) don’t count as advanced APMs under MACRA, but they are still well-positioned for success because they earn the highest possible score in the clinical improvement activities category of MIPS. Also, if you’re planning to move toward an advanced APM, taking part in a PCMH can give you a head start on preparing for the transition, Quintero notes.

7. Small and solo practices will be able to report for MIPS as part of “virtual groups” with other small practices starting in 2018. Until then, small practices can seek technical assistance from their regional extension center if needed. Virtual groups are intended to level the MIPS playing field between small practices and larger ones, which may have stronger tech resources and more ability to pool risk.