MACRA was passed and signed into law in April 2015. MACRA introduces two new payment tracks for physicians and aims to transition Medicare from volume-based to value-based payment models. If you are a Medicare participating family physician, you are an eligible clinician (EC) for the purposes of participation in MACRA. As an EC, you will participate in one of the two MACRA Quality Payment Program (QPP) pathways, the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Model (Advanced APM).
Many family physicians will pursue participation in an Advanced APM, but a large number will initially participate in the MIPS pathway. If you take no action, you will be included in the MIPS cohort for the performance period. 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.
Failure to report at least one measurement or activity by Monday, October 2, 2017, will result in a negative 4% adjustment in 2019.
- 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.
Eligible clinicians will receive a 5% bonus if they receive 25% of Medicare Part B payments, OR see 20% of patients through the APM.
Remember, if you engage in the QPP program at any level during the 2017 performance period, you will not receive a negative payment adjustment in 2019.
- Low Volume Threshold – If your Medicare Part B allowable charges are less than $30,000 a year or you do not provide care to more than 100 Medicare Part B fee-for-service patients in a year, you are exempt from participation in the QPP. However, if your Medicare allowable charges exceed $30,000 a year and you provide care to more than 100 Medicare fee-for-service patients a year, you are part of MIPS.
- Initial Medicare Participation Year – If 2017 is your first year as a Medicare participating physician, then you are exempt from participation in the MIPS program.
- Advanced APM — If you are part of an Advanced APM, you are exempt from the MIPS program.
Do Not Panic
There are more than 900,000 physicians and other health care professionals participating in the Medicare program. Your current capabilities likely are far ahead of many of these ECs. Remember, practice transformation is a journey not a destination, and you should not try to master MIPS or an APM in a weekend. Take your time and be thoughtful, but diligent in your approach. I encourage you to think of the MIPS program as four functions — not a comprehensive regulation. You likely are already doing these four things in your practice, so you are farther along than you may think. If you are not engaged in these activities, it is OK because you have time but make sure you hit the Monday, October 2, deadline!
- Report quality
- Use an electronic health record (EHR)
- Become a medical home or engage in performance improvement activities
- Understand the resource use (cost) of your patients.
Physicians who plan to participate in the MIPS track of the QPP should learn everything they can about the four categories on which their performance will be judged: quality, cost, improvement activities, and advancing care information (ACI).The ACI category may be the least understood, and so to help family physicians get up to speed, the AAFP is offering a free webinar about it on Wednesday, August 23, from 1-2 p.m.
Registration is now open for this live event, titled Your Prescription for MIPS: Demystifying Advancing Care Information. Erin Solis, an AAFP regulatory compliance strategist, will guide participants through a review of the ACI performance category to ensure that physicians come away with a thorough understanding of the scoring criteria and more.
Can’t view this live? Don’t worry, the webinar will be archived for later viewing.
Also on Wednesday, August 23, the AAFP invites participation in a Twitter chat session using #AAFPChat from 8-9 p.m. with family physician Amy Mullins, MD, the AAFP’s medical director of quality improvement.
Visit the AAFP website for more great resources!