What do MACRA and MIPS mean for your practice?
In January 2015, the Department of Health and Human Services made a historic announcement committing to shift Medicare payments from a fee-for-service to a fee-for-value reimbursement system, with 85% of fee-for-service payments tied to quality or value by the end of 2016. In April 2015, Congress passed MACRA (formally known as the Medicare Access and CHIP Reauthorization Act of 2015) 92-8 in the Senate and 392-37 in the House. MACRA introduces a new Medicare payment system focused on achieving the goal of tying payment to value.
For physicians with Medicare patients, MACRA impacts your practice in 3 ways:
- Introduces new reporting requirements for your practice
- Puts more of your Medicare payments at risk
- Provides significant incentives encouraging your practice to better manage the total cost and quality of care for your Medicare patients
MACRA 101: An Introduction to Medicare Changes
MACRA reforms Medicare’s payment system for physicians. The law shifts Medicare to a value based system, tying your Medicare payments to cost and quality performance.
MACRA changes Medicare payments by:
- Repealing the current, flawed sustainable growth rate (SGR) methodology or “the doc fix”
- Setting extremely modest baseline increases to your Medicare payments over 10+ years
- Consolidating current fee-for-service programs (i.e., Meaningful Use, Physician Quality Reporting System, and Value Based Payment Modifier) into a single, fee-for-service based value program (i.e., MIPS)
- Creating a new, separate alternative payment track for physicians known as the Advanced Alternative Payment Model (AAPMs)
For more information on MACRA, download our informational guide.
For more information on the MACRA Final Rule, listen to our overview webinar presented by Aledade’s Policy Lead, Travis Broome.
Track 1: Merit-Based Incentive Payment System (MIPS )
Starting in 2019, MIPS will replace Medicare’s current fee-for-service payment system. CMS estimates that 95% of physicians will receive Medicare payments under this track. Reporting requirements begin in 2017, with practice incentives and penalties starting in 2019. MIPS will impose an adjustment of up to +/- 4% to all of your Medicare payments in 2019, ramping up to +/- 9% in 2022 and beyond. Exceptional performers are eligible to receive a bonus of up to 10% in additional Medicare revenue per year, starting in 2019.
As a result of these payment changes, MIPS will create large variations in how much different physicians are paid for the same service. For example, $100 in Medicare payments today could be as much as $115 in payments by 2020 for top performers. In contrast, physicians with no quality reporting or poor performance could receive payments as low as $95.
For more information on MIPS, download our informational guide.
Track 2: Advanced Alternative Payment Models (AAPMs)
Physicians participating in Advanced APMs are exempt from MIPS and will be placed into a separate payment track. These physicians receive 5% in annual Medicare incentive payments from 2019 to 2024. They are also exempt from MIPS reporting requirements after the first year of reporting. CMS estimates that 5% of physicians will receive Medicare payments under this track. Advanced APMs qualified for this track include: Medicare Shared Savings Program – two-sided risk, Next Generation ACO Model, and Comprehensive Primary Care Plus, among others.
The Next 5 Years: Managing the Transition
With the introduction of MACRA, your practice will face major changes over the next 5 years to reporting requirements and Medicare payments. Several current programs (i.e., Meaningful Use, Physician Quality Reporting System, and the Value-Based Payment Modifier) will end while the new 2-track payment program (i.e., MIPS and Advanced APMs) will begin in 2019. In the midst of this change, your practice needs a survival plan to remain financially stable.
Learn more about how Aledade partners with practices nationwide to help them through this transition.
Our Policy Expertise
At Aledade, our team brings together a wide range of experts with vast experience in regional and federal healthcare policy.
Healthcare Policy Lead
Travis Broome, our healthcare policy lead, is a veteran of the Center for Medicare & Medicaid Services (CMS). Before joining the Aledade team, Travis served as a Regional Director at CMS, overseeing Medicare Part A & B, EHR, and ACO operations across five states. Prior to this, Travis lead the team that crafted the early rounds of meaningful use regulations for the EHR Incentive Programs. Travis received Masters of Public Health, and of Business Administration in Health Care Organization and Policy from the University of Alabama at Birmingham. Travis works closely with our CEO and co-founder Dr. Farzad Mostashari and the rest of the Aledade team to ensure that health reform in Medicare, Medicaid and the private sector puts independent, primary care physicians at the center of the transition to value based payment. Travis has published and presented extensively on value based payment models, with his work featured by the American Journal of Managed Care (AJMC), the Health Information and Management Systems Society (HIMSS), the American College of Physicians (ACP), the National Association of ACOs (NAACOs), and the Centers for Disease Control and Prevention (CDC), among others.