MDNews - Cleveland-Akron-Canton

THE CENTERS FOR Medica re & Medica id Ser vices (CMS) recent ly issued it s f i na l r u le i mplement i n g t he Q ua l it y Pay ment P rog ra m creat ed by t he Med ica re Access a nd CHIP Reauthorization Act (M ACR A). M ACR A ended the Sustainable Grow th Rate formula that has threatened physi- cians with payment cliffs for 13 years and moved the payment s yst em t owa rd rewa rd i n g h i g h-va lue, pat ient- cent ered ca re. Ef fective Ja n. 1, 2017, M ACR A applies to physicia ns a nd adva nced practice nurses who bill more tha n $30,000 to Medica re a nd prov ide ca re to more tha n 100 Medica re patients per year. Certain other limited exceptions may apply. M ACR A establishes t wo tracks for physicia n pay ment: the Merit-Based Incentive Payment System a nd a lternative pay ment models. Depending on the track chosen a nd data submitted by Ma rch 31, 2018, Medica re pay ments in 2019 w i l l be adjusted up, dow n or not at a l l. If physicia ns don't pa r ticipate, they will receive a negative 4 percent payment adjustment in 2019. This adjustment g rows to a potentia l of 9 percent sta r ting in 2022. MERIT-BASED INCENTIVE PAYMENT SYSTEM (MIPS) M ACR A repla ced t h ree Med ica re repor t i n g prog ra m s: Mea ning f ul Use, the Physicia n Qua lit y Repor ting System a nd t he Va lue -Ba sed Mod i f ier w it h M I PS . T hese t h ree prog ra ms w i l l be incor porated into the new per forma nce progra m, which conta ins four categories: qua lity, adva ncing ca re information (ACI), improvement activ ities a nd cost. There a re nea rly 300 dif ferent qua lit y mea sures a nd 100 improvement activities available to medica l practices to select for MIPS. The measures for ACI a re limited a nd pre-def ined. CMS will not count cost in the MIPS score in 2017. WHAT PHYSICIAN PRACTICES MUST DO IN 2017 TO AVOID A MIPS PENALT Y IN 2019 To avoid the pena lty, practices must report a minima l amount of information in 2017. They ca n repor t just one qua lity mea- sure or one improvement activity, or the ACI base measures. Practices that elect to submit between 90 days and a full year of 2017 data may earn a positive payment adjustment, depending on how much data are submitted and on the practices' qua lity results. CMS ex pects the bonuses will be limited a nd may not exceed 1 percent. Physicia ns ca n repor t t heir MIPS data indiv idua l ly or as a g roup under the sa me ta xpayer identif ication number. Groups will submit data for each of the MIPS categories, a nd a ll physicia ns in the g roup will receive the sa me score a nd payment adjustment. ALTERNATIVE PAYMENT MODELS (APMs) A n a lternative pay ment model is a pay ment approach that provides incentives to physicians to provide high-qua lity and cost-eff icient ca re. A lternative payment models ca n apply to a specif ic clinica l condition, a ca re episode or population. As physicians move from fee-for-ser vice to va lue-based payment models, M ACR A created new incentives for physicia ns to pa r ticipate in A PMs. Adva nced A PMs a re a subset of A PMs a nd give physicia ns oppor tunit y to ea rn more for ta king on some risk related to patients' outcomes. Physicia ns pa r ticipating in a n Adva nced A PM may ea r n a 5 percent Medica re i ncentive pay ment during 2019 through 2024 a nd be exempt from MIPS repor t- ing requirements. A few exa mples of qua lif ied Adva nced A PMs a re the Comprehensive Prima r y Ca re Plus (CPC+) Model, Medica re Sha red Sav i ngs Prog ra m Accou nt able Ca re Orga nizations tracks 2 a nd 3, a nd the Nex t Generation Accountable Ca re Orga nization Model, a mong others. NEXT STEPS Physicia ns a nd practice leaders should consider their strate- g ies to be prepa red for t he move f rom fee-for-ser v ice to va lue-based reimbursement. Long-terms plans should include meeting the new requirements while providing mea ning ful benef it to their practices a nd patients. F red Lu eck e i s th e P ra cti ce L ea d e r of Health care an d Accounting Services at CBIZ , MHM, LLC, and Mayer Hoffman McCann PC, an independent CPA firm in Northeast Ohio. ■ Changing How Physicians Get Paid BY FRED LUECKE, CPA, CMPE MACRA — MACRA — 2 4

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