MACRA Countdown Continues Nine Months to Measurement Year

April 05, 2016
Heather Lavoie, Chief Strategy Officer, Geneia


MACRA is Coming

In just a few short months, 2017 will be upon us. As a physician, your performance will be measured and scored with either the Merit-Based Incentive Payment System (MIPS) or through your qualified alternative payment models (APMs). This score will determine your adjustment for all of your part B 2019 Medicare reimbursements. Every point above or below the threshold will translate into either a positive or negative adjustment. This adjustment applies to every Medicare claim you submit until the next year’s measurement.

Big Impact to Your Reimbursement Rates

For 2019, the maximum adjustment (up or down) is capped at 4 percent. This cap quickly grows over five years to a whopping 18 percent swing – 9 percent positive or negative – in 2024.

According to the Kaiser Family Foundation, for one-third of primary care physicians, at least half of their patients have Medicare. This means that, for 30 percent of physicians, 50 percent of their revenue stream will be adjusted up or down, beginning with 4 percent and growing to 9 percent. Stop for a moment and think about your Medicare population. What would it mean to you to have half of your overall revenue reduced by 4 percent? 5 percent? 7 percent? 9 percent?

Automatic Increases to Fee-For-Service Rates Will Not Be Enough

Predictable and stable increases have replaced the sustainable growth rate (SGR) scramble of the past. However, the increases are nominal and designed to help with your near-term transition to the imminent value-based systems. The FFS automatic increase is only 0.5 percent annually until 2019. After that, there are no scheduled increases. This is not enough.

Merit-Based Incentive Payment System (MIPS) Impacts Nearly All Providers

At Geneia, we believe the vast majority of physicians will land on the MIPS track. This is because only the “most advanced” alternative payment models are eligible for the APM track. While alternative payment models are gaining in popularity and adoption, they are the exception and not the rule when it comes to today’s medical landscape.

Transitioning From FFS to MIPS

You are already familiar with three value-based reporting measures – Physician Quality Reporting System (PQRS), Value-Based Modifier (VBM) and Meaningful Use Stage 3 (MU3). These measures are the key to understanding and transitioning successfully to MIPS. The newly released core value measures reveal that 85 percent of the MIPS composite score is based upon measures drawn from these three existing programs.

Ensuring that you have the systems and resources in place to provide accurate and complete reporting for PQRS, VBM and MU3 now will be a significant advantage when the MIPS measurement kicks in next year.

Stay abreast of breaking news. The implementation of MACRA is a dynamic and living process. Throughout 2016, we expect many new developments as rules are proposed, discussed and finalized. To help you get the information you need, we are offering free resources through a variety of mediums:


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