Healthcare

In earlier blogs on MACRA, we’ve discussed a series of topics, including the flexibility in the first reporting year 2017 and the “Pick Your Pace” option in MIPS.

Risk tolerance is an interesting thing. Those who make the biggest bets often are actually control freaks—maybe because they know that, by having a strong grasp on the factors that influence the deal, they greatly increase the likelihood that they will come out ahead.

By banding together into what CMS has termed “virtual groups,” solo practitioners and small medical groups can take advantage of significant flexibility currently available to help them succeed in the Merit-based Incentive Payment System (MIPS).

In Part 1 of this series, we answered some FAQs about these MIPS virtual groups. In Part 2, we share items to consider before joining a virtual group.

The previous installment of this blog series described the CMS Innovation Center and its mission to test innovative payment and delivery models and to implement the MACRA Quality Payment Program (QPP).

The QPP is designed to help achieve HHS’ goal of tying half of Medicare fee-for-service payments to quality or value through Advanced Payment Models (APMs) by 2018. Advanced APMs, one of the two tracks of MACRA, allows physician practices to earn more by assuming some financial risk related to patients’ outcomes. Certain Accountable Care Organizations (ACOs) in the Medicare Shared Savings Program (MSSP), including the new MSSP Track 1+ ACO, qualify as Advanced APMs.

With the proposed changes to the Quality Payment Program (QPP) released Wednesday, the new administration aims to reduce some administrative complexity and extend the flexibility that CMS provided in the initial year of the program, while incentivizing more providers to move into Alternative Payment Models (APMs).

MACRA’s anticipated future impact on the healthcare industry has many provider organizations contemplating what actions and resources are necessary to participate in alternative payment models (“APMs”). Provider organizations facing the immediate options of getting involved with a CMS or commercial APM have significant operational decisions to make that will impact the future make-up of their organizations. Today we will discuss some of the considerations in preparing for APM participation.

Rural hospitals have some tough decisions to make about their level of participation in the new CMS Quality Payment Program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). 

For a number of reasons, the MACRA cards are stacked against small and rural providers. Given the limited number of Advanced Alternative Payment Models (APMs) that are being approved, many providers will start out in the Merit-Based Incentive Payment System (MIPS), and that track offers limited upside potential compared with APMs.

It is important to recognize that the road to long-term success does not end with the implementation of the Merit-based Incentive Payment System (MIPS). In CMS’ own words, MACRA’s final rule was established, in part, to incentivize and promote participation in Advanced Alternative Payment Models (APMs). These incentives include a 5% participation bonus from 2019 to 2024 and a 0.5% annual increase above the MIPS track beginning in 2026.

Like it or not, MACRA is here. MACRA created the new Quality Payment Program (QPP), comprised of two pathways to higher quality: the Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (Advanced APMs). MACRA changed the rules, leaving many to face an uncertain future. Amid the uncertainty, however, one thing is sure: passivity will be costly. Indecision will not prevent or delay physician’s placement into the quality and efficiency compensation measurements of MIPS.

Wait-and-see is no longer a viable strategy for payment reform—especially with regard to MACRA implementation.

In my 30 years serving healthcare practices, I have seen innovations come and go. I certainly understand the impulse to sit back and let the dust settle before rushing to implement a new regulation, and the steady Republican drumbeat of “repeal and replace” is enough to give any provider pause.

I've just returned from the National MACRA MIPS/APM Summit in Washington, D.C., where the overarching discussion centered on how to create and implement strategies that pay physicians fairly, while controlling spending in the Medicare program. It's a question we've wrestled with for almost 20 years and a challenge we must solve.

Virtual healthcare is a godsend to struggling healthcare systems as they try to offer the right care in the right setting. Every day, these systems face enormous pressure to provide both high-quality and cost-effective healthcare to their communities. Their clinics are filled with scheduled patients, while others wait for a “work in.”

A big news item in healthcare is CMS’ recent release of the MACRA Final Rule, which articulates CMS’ future direction for Medicare Part B. With the Final Rule, CMS makes clear the following strategic objectives in developing MACRA’s new Quality Payment Program (QPP):