The Centers for Medicare & Medicaid Services (CMS) changes for 2017 are centered on changing the way physicians are reimbursed for care so that they can focus on giving quality care and making patients healthier. Let’s break down MACRA and MIPS as it may relate to you.

What is MACRA?

In April 2016, CMS published a proposed regulation to implement MACRA, the Medicare Access & CHIP Reauthorization Act. MACRA replaces the contentious Sustainable Growth Rate (SGR) model and provides new tools, models, and resources to help physicians give their patients the best possible care. MACRA created the Quality Payment Program (QPP), the framework through which physicians are paid for the value of the care they provide as opposed to being paid for the quantity of care they provide on a fee-for-service payment model. The QPP consists of two tracks physicians can choose from based on practice size, specialty, location, or patient population: MIPS and APMs.

What is MIPS?

MIPS, the Merit-based Incentive Payment System, is a single incentive program that consolidates three current pay-for-performance programs within in: the Physician Quality Reporting System (PQRS), Value Based Payment, and the Medicare EHR incentive program for eligible professionals (aka Meaningful Use). MIPS will go into effect in 2018 and begin adjusting payments in 2019. Physicians will be ranked on quality and cost of care vs. their peers based on four performance categories that will make up a composite performance score (CPS) of a potential 100 points. The categories and how they weigh into the score are as follows:

• Quality of Care – 50%
• Resource Use/Cost – 10%
• Clinical Practice Improvement Activities – 15%
• Advancing Care Information – 25%

Physicians may submit their individual score or a score for their entire group practice, which will be published by CMS on Physician Compare. After a year’s worth of data in 2017 is reported to CMS, a national threshold will be calculated to determine an appropriate pay adjustment for those physicians performing above/below average. For every physician that earns more through MIPS, there will be one who earns less – rewarding quality over quantity. Those performing poorly may see their payments cut by up to 9%, whereas those performing well may receive an adjustment up to 4% in 2019, increasing to 9% by 2023. Please note that note that MIPS does not apply to hospitals, meaning the EHR incentive program for hospitals will continue.

In the next Vetters Enterprises blog we will discuss Advanced Alternative Payment Models, or APMs.