Last year, MACRA become the law of the land, replacing Meaningful Use, PQRS, and The Value-based Modifier. The goal? Consolidate the existing incentive programs and continue to expand ways to reduce costs while improving the quality of care.
So, first things first. What is MACRA and how does it work? MACRA is a larger piece of legislation that contains a program called the Quality Payment Program (QPP). The QPP is the part that relates to CMS payments, and it has two paths. Most providers will participate in the Merit-based Incentive Payment System (MIPS). However, there is also the Advanced Alternative Payment Models (APMs) path.
You belong to an Advanced APM if you participate in one of these payment models:
Comprehensive ESRD Care (CEC)
Comprehensive Primary Care Plus (CPC+)
Next Generation ACO Model
Shared Savings Program – Track 2
Shared Savings Program – Track 3
If you are in one of these models, keep doing what you are doing and do not participate in MIPS. You may earn a 5% incentive in 2019.
Everyone else who qualifies participates in MIPS. This series of blog posts will walk you through what MIPS is, how it works, and what role patient relationship management can play in helping you attest successfully.
While it is a change for providers, the new program does offer some flexibility in the form of Pick Your Pace. Essentially, if you haven’t done MU or PQRS before, you can take a simpler approach to try to avoid a penalty. If you were participating in those programs prior to 2017 then you can largely keep doing what you are doing with just a few modifications and additions.
Since the potential incentives and penalties are substantial over time (up to 27% incentive in 2022), it may be worth jumping in whole hog though. It’s too late for maximum participation in 2017, which would need a full year of reporting, but it isn’t too late to avoid the penalty or even get a small incentive.
If you aren’t in an Advanced APM and meet the following requirements then you should participate in MIPS:
- You are a Physician (Doctors of Medicine or Osteopathy, Doctors of Dental Surgery or Dental Medicine, Doctors of Podiatric Medicine, Doctors of Optometry, Chiropractors), Physician assistant, Nurse practitioner, Clinical nurse specialist, or Certified registered nurse anesthetist.
- You bill more than $30,000 in Medicare Part B claims in the year.
- You see more than 100 Medicare Part B patients in the year.
You do not need to register to participate. The best resource to find out more about the program is qpp.cms.gov. And, watch for our next post where we will walk you through the three categories for MIPS in 2017 and how to participate in the Test or Partial Pace options to avoid a penalty.