MACRA


On April 27th the Centers for Medicare and Medicaid Services (CMS) released their new proposed rule for the meaningful use, PQRS replacement.  MACRA is the Medicare Access and CHIP Reauthorization Act of 2015.  The rule is close to 1,000 pages and can be found here: proposed rule.  Most of the pages are just defining the new slew of acronyms you need to remember.  Not really but it feels that way. Here are a few of the MACRA defined acronyms that we need to familiarize ourselves with.

MIPS

MIPS stands for merit based incentive payment system. This is the first category that most providers will fall into.  It is a combination of PQRS, Value Modifier, and meaningful use EHR. MIPS will produce a composite score based on 4 weighted categories.

  • 50% Quality
  • 25% Advanced Care Information
  • 15% Clinical Practice Improvements
  • 10% Resource use

The composite score will be compared to other practices and you may have an adjustment up or down based on how you are doing compared to other practices.  This will be 4% up or down in the year 2019 and will go up a percentage a year until it hits 9%.

APMs

APMs stands for Alternative Payment Models.  This model will put a larger financial risk on your practice but by embracing the model, can lead to larger financial reward. APMs payment is based on use of EHR and bases payment on quality. Providers are also set to receive a 5% lump sum payment for years 2017-2019.  After that, providers are set to receive higher fee schedule updates based on threshold score.

Get Ready for MACRA

The reporting begins in 2017 for the payment year 2019.  Start preparing now because it could have drastic effects on your bottom line.   The rules are currently just the proposed rule but it is unlikely to change heavily before the final rule comes out.  We can work with you to make sure you are prepared as the practices we are currently managing.  Call 304-955-6200