Solutions For

Solutions For MACRA

Did you know in 2019 there will be a 16% difference in income between high and low performing providers? By 2022 that number will potentially increase to 36%.

Recently a new law has been signed that will have a significant impact on accelerating the transition to value-based care. The MACRA law, which stands for Medicare Access and CHIP Reauthorization Act. MACRA will replace the Sustainable Growth Rate formula which tied Medicare physician spending to GPD growth in the past. MACRA creates a fork in the road for physicians, who must adopt one of two models:

1. Alternative Payment Models (APMs)
2. Merit-Based Incentive Payment System (MIPS)

If a Physician does not qualify for APMs, they will automatically be enrolled in the MIPS model.

MIPS

Beginning in 2017 (adjusted reimbursements in 2019), Providers will receive a MIPS score which will significantly change their Medicare reimbursement. Providers will be evaluated on 4 different categories to make up a 100 point MIPS score.

  • Quality
  • Resource Use
  • EHR Use
  • Clinical Improvement

CMS is no longer just measuring quality and resource utilization. Now the focus is moving deeper into value-based care and taking into account preventative care efforts, as well as the provider’s ability to engage patients. For all physicians participating in MIPS, an official MIPS composite score will be listed online in the Physician Compare Portal. Located on www.medicare.gov.

APMS

APMs, or Alternative Payment Models, Under the MACRA law, physicians may decide to go with APMs as opposed to the MIPS model. The CMS Innovation Center is in the process of developing new APMs for specialists, smaller practices, and other practices that have risk-based contracts with private or state payers. Each eligible professional (EP) in an APM will receive an annual 5% bonus based on their Medicare reimbursement from the year prior.

The proposed rule includes a list of models which qualify as Advanced APMs under MACRA including:

  • Comprehensive ESRD Care Model (Large Dialysis Organization arrangement)
  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program – Track 2
  • Medicare Shared Savings Program – Track 3
  • Next Generation ACO Model
  • Oncology Care Model Two-Sided Risk Arrangement (2018)