Source: American Academy of Family Physicians
MACRA, passed and signed into law in April 2015, introduces two new payment tracks for physicians and aims to transition Medicare from volume-based to value-based payment models. Under MACRA, eligible clinicians (ECs) will participate in either the Merit-Based Incentive Payment System (MIPS) or an Advanced Alternative Payment Model (AAPM). MIPS and AAPMs are collectively referred to as the Quality Payment Program (QPP). The initial performance period begins in 2017.
With the MIPS track, ECs receive a final score based on performance in four performance categories: quality, cost, advancing care information (ACI), and improvement activities (IA). A clinician’s performance in 2017 determines Medicare Part B payment adjustments for 2019.
To give ECs more time to learn about and adjust to QPP, the Centers for Medicare & Medicaid Services (CMS) deemed 2017 a transition year to “Pick Your Pace.” To avoid a 2019 negative payment adjustment, ECs must select from one of four Pick Your Pace options:
- Test – Submit data for one quality measure, OR one improvement activity, OR the four required ACI measures and avoid a negative payment adjustment. Read a practice scenario for the test option.
- Partial Participation – Submit at least 90 days of data for more than one quality measure, OR more than one improvement activity, OR more than the four required ACI measures and avoid a negative payment adjustment. Partial participation also allows ECs to possibly receive a small positive payment adjustment. Read a practice scenario for the partial participation option.
- Full Participation – Submit at least 90 days of data for all required quality measures, AND all required improvement activities, AND all four required ACI measures to avoid a negative payment adjustment. Full participation also allows ECs to possibly receive a moderate positive payment adjustment. Read a practice scenario for the full participation option.
- AAPM – Eligible clinicians will receive a 5% bonus if they receive 25% of Medicare Part B payments, OR see 20% of patients through the AAPM.
Failure to report any data in 2017 will result in a negative 4% payment adjustment to Medicare Part B claims in 2019.
To prepare for 2017, review and evaluate your existing activities that meet MIPS reporting requirements. By assessing your current activities, you can select which Pick Your Pace option works best for you and your practice. You must participate in one of the four Pick Your Pace options to avoid a negative payment adjustment in 2019.
Physicians can review quality measures, improvement activities, and ACI measures by visiting the CMS QPP website.
For more information, download the AAFP’s Making Sense of MACRA: Pick Your Pace supplement and read “Making Sense of MACRA, Part 2: Value-Based Payment and Your Future” from Family Practice Management.