Physician Hospital Organization
Understanding Medicare Payment Reform
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While the first year for MACRA is 2019, the AAFP anticipates that performance in 2017 may determine the threshold for the first year of MIPS in 2019.
If you haven’t reported data on quality measures through the Physician Quality Reporting System (PQRS) or as part of meaningful use, start as soon as possible. Penalties for not reporting or for low quality may impact you this year.
If you submitted quality data during the last calendar year, you should have access to your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement.
If your practice doesn’t provide chronic care management (CCM) services, consider the cost-benefit opportunity for increasing revenue to support needed practice transformation or quality improvement projects. Medicare began paying for CCM codes on January 1, 2015.
MACRA impacts Medicare payments in three ways.
Repeals the flawed Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians.
Creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment:
Merit-based Incentive Payment System (MIPS), and
Alternative Payment Models (APMs)
Consolidates three existing quality reporting programs, plus adds a new program, into a single system through MIPS:
Physician Quality Reporting System (PQRS)
Value-based Payment Modifier (VBPM)
Meaningful use (MU)
Clinical practice improvement activities (CPIA)
The following is a timeline for MACRA implementation:
2016 through 2019: MACRA establishes a 0.5 percent physician fee schedule update each year.
January 2019: Based on qualification and eligibility, physicians may enter the APM track or the MIPS track.
2020 through 2025: Medicare physician fee schedule updates remain at 2019 levels with no updates.
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