Physicians may be breathing a sigh of relief that the Centers for Medicare & Medicaid Services (CMS) has issued final rules for the Medicare Access and CHIP Reauthorization Act (MACRA). Much of the uncertainty is over, reports and commentaries are flowing in, and the consensus is that the program is more flexible and physician-friendly than the proposed rules issued for comment earlier this year. There is a large number of clinicians – 380,000 practitioners – who are not subject to the reporting and payment requirements, providing hoped-for relief to smaller practices. The intent of the new Quality Payment Program (QPP) is to transition clinicians from fee-for-service care to value-based care and is the biggest shift in physician reimbursement since 1965.
Concern about the effects of MACRA implementation have been strong and CMS received 4,000 comments and conducted listening tours that attracted nearly 100,000 participants. Yet, as of July 2016, a stunning 50 percent of non-pediatric physicians had never even heard of MACRA. Some experts saw this gap as a recipe for a disastrous start to a system that would ultimately penalize physicians who couldn’t ramp up in time.
The basics of the Quality Payment Program
- The QPP applies to physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who care for at least 100 Medicare patients or bill Medicare more than $30,000 a year.
- The program has two tracks for participation – through an Advanced Alternative Payment Model or through the Merit Based Incentive Payment System.
- For some of those eligible, collection of data should begin Jan. 1, 2017, so wise clinicians will review resources now to determine which pathway best fits their practice. Some experts recommend collecting data Jan. 1 even if not technically not required, to identify gaps in plenty of time to correct them.
Resources for understanding MACRA and QPP
- CMS unveiled a new website designed to answer questions about the rules.
- The American Medical Association issued a toolbox to help clinicians come to grips with what’s required of them.
Industry commentary about MACRA, QPP and quality
- Becker’s Hospital Review lists 10 key things to know about the new rules.
- A statement from the Medical Group Management Association points out both strengths and weaknesses of the program.
- A Modern Healthcare editor questions whether the so-called “quality movement” is asking the right questions and collecting the right data.
Many experts before and after the announcement were advising clinicians to avoid procrastination. Even with new flexibility, that seems like good advice.
The road from fee-for-service to value-based care is sure to have more twists and turns in it and the administrative burden of providing care is top of mind for everyone. Physicians need all the help they can get.
ABILITY offers physicians and clinics a wide array of resources to help with the administrative and clinical complexities of healthcare. Browse the Resource Center here.
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