The new Centers for Medicare and Medicaid Services (CMS) quality payment program, which will determine Medicare physician payment starting in January, has three key goals: Better care, smarter spending and healthier people. Ashby Wolfe, MD, MPH, believes there’s one more important element that isn’t stated in the triple aim. “I’d like to add a fourth pillar to those goals: Joy in practice,” Dr. Wolfe said. “CMS recognizes the importance of allowing physicians to do what they do best with fewer administrative burdens.”
The good news? MACRA’s proposed quality payment program is designed to address all four goals, Dr. Wolfe told physicians during a practice management session at OMED 2016 in Anaheim. Dr. Wolfe, a practicing family medicine physician, serves as chief medical officer for CMS Region 9, which includes several West Coast states and Hawaii.
Although the final rule on MACRA won’t be issued until later this fall, CMS recently indicated that physicians will have wide latitude for participating in the quality payment program in 2017.
Broadly, the program offers physicians two pathways: reporting quality data through the merit-based incentive payment system (MIPS), which streamlines several existing CMS incentive programs and adds one new category, or participating in a qualifying advanced alternative payment model (APM).
For 2017, most physicians will participate in the MIPS, Dr. Wolfe said, and they’ll have three ways to do so. Physicians can test the MIPS by submitting some data at any time during the year. If you’re ready to jump in, you can report all data for part of the year or all data for the complete calendar year. Participating in MIPS in any way will exempt you from penalties in 2019, and you may be eligible for bonuses depending on your performance and how much data you submit.
If you qualify as participating in an advanced APM for 2017, you won’t have to report for the MIPS and and you’ll be eligible for a bonus payment of up to 5%. Because the MACRA quality payment program applies only to Medicare payments, Dr. Wolfe noted, the electronic health record incentive program for Medicaid and for hospitals will remain unchanged.
In a Q&A system with DOs in the audience, Dr. Wolfe emphasized that the MACRA quality payment program will benefit physicians in several ways:
- Predicting payment adjustments will become easier. “Under the previous system, physicians were reporting for three different CMS programs, and the meaningful use program was set up such that if you did not successfully meet every expectation for attestation, you received no credit under that program,” Dr. Wolfe explained. “With the proposed quality payment program you’ll only be reporting for one program, and even if you don’t meet all the requirements for the advancing care information component, which replaces meaningful use, you’ll still get credit if you report some information and at least a partial score.”
- Avoiding a penalty in 2019 is relatively easy. “Your performance in 2016 under existing quality programs—the physician quality reporting system, meaningful use of electronic health records, and the value-based payment modifier—will still affect your payment in 2018. That hasn’t changed,” Dr. Wolfe noted. “However, by submitting even a little quality data through the MIPS pathway of the proposed quality payment program in 2017, you’ll avoid being penalized in 2019. It’s the first step to a fresh start.”
- Under MACRA, CMS will be providing more timely, relevant feedback. Currently, CMS’s quality and resource use reports, which tell physicians how they are doing in the physician quality reporting system, arrive six to nine months after data submission and can be challenging to decipher, Dr. Wolfe acknowledged. When MACRA launches in 2017, CMS aims to provide physicians with clear, timely feedback on how they’re doing compared with peers.
Ultimately, Dr. Wolfe said, it’s important for physicians to look beyond Medicare to see that private payers, and patients themselves, are interested in the move toward quality, coordinated care. “Patients want to engage with us in this conversation, and these days I have patients regularly asking me questions by email as well as in the office,” Dr. Wolfe said. “Times are changing, and our practices need to change as well.”
Post updated Sept. 19, 2016.