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Things to Know About MACRA Cheat Sheet (DRAFT) by [deleted]

This is a draft cheat sheet. It is a work in progress and is not finished yet.


CMS has released its proposed final rule for MACRA (Medicare Access & CHIP Reauth­ori­zation Act of 2015). Though not finalized, MACRA creates a new framework for rewarding providers for better, lower cost, patien­t-c­entered care.


1. Prepare now. Though it could change in the final ruling (due by the end of 2016), the MACRA timeline is aggres­sive. The first perfor­mance year starts Jan. 1, 2017, and impacts payments in 2019.
2. MACRA affects most providers across the country. Under MACRA, clinicians will choose one of two payment options: MIPS or APMs.
MIPS (Merit­-based Incentive Payment System) combines the Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-­based Payment Modifier Program (VM) programs. Clinicians get a composite score based on perfor­mance across four areas, which serves as a modifier for Medicare Part B reimbu­rse­ments.
APMs (Alter­native Payment Models) include healthcare organi­zations with two-sided risk-based payment models such as Next Generation ACOs and Compre­hensive Primary Care Plus (CPC+).
3. Everyone reports under MIPS in 2017. While MACRA offers two tracks (MIPS and APMs), all providers will report under MIPS in 2017 unless they are new to Medicare or bill very low Medicare volume. CMS will then determine which clinicians qualify for APM status.
4. Reporting is a full calendar year. The perfor­mance period for the new Quality Payment Program (QPP) tracks is a full calendar year, not 90 days. Perfor­mance during 2017 will be reflected in 2019 payment adjust­ments.
5. MIPS payment adjust­ments are complex. There are four categories that determine a clinic­ian’s MIPS score: quality, cost, care coordi­nation, and EHR use. Each category has a different weight, and relative weighting changes over time.
6. Under MIPS, most clinicians will see a payment adjust­ment. With other CMS programs, average performers saw no adjust­ment. By contrast, under MIPS most clinicians will. Those with a MIPS score above or below the national threshold will see a corres­ponding upward or downward payment adjust­ment. According to CMS, the majority of indepe­ndent practices are expected to see a pay cut.
7. We won’t see a lot of APMs at first. Only a small number of groups will initially meet APM requir­ements, but CMS believes that over the long term, the Advanced APM will become the preferred choice for providers.
8. Reporting under these programs won’t be cheap. CMS estimates MIPS Quality Reporting will cost about $723 per clinician per year, and take about 11 hours per reporting category each year.
9. Remember Meaningful Use? It’s not going away (yet). QPP does not change hospital or Medicaid MU. Medicaid MU partic­ipants who also bill Medicare will need to partic­ipate in both Medicaid MU (through 2021) and MIPS.
10. Your data will be public. MACRA requires that each physic­ian’s MIPS composite score be posted to the Physician Compare website, along with the physic­ian’s score in each of the four perfor­mance catego­ries.