Many physicians (aka... Eligible Professionals and Hospitals) rejoiced at hearing the 'death' of MU when CMS's acting administrative director Andy Slavitt said 'Meaningful Use(MU) Program as we know it is effectively over' on January 11, 2016 at the J.P. Morgan Healthcare Conference..Alas! We failed to really listen to all of his words.

MACRA Impact on Medicare providers

MACRA stands for the Medicare Access & CHIP Reauthorization Act. MACRA impacts Medicare payments in three ways. It repeals the Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians.It creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment. The Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs).

The Merit-based Incentive Payment Program (MIPS) omits requirements such as clinical decision support and computerized provider order entry in physician electronic health-records.Healthcare providers are allowed to choose from a number of categories.


MACRA relationship to Meaningful Use

2016 is the final year physicians will be subject to penalties under the meaningful use program as it is configured now, and 2017 will be the first year physicians will be assessed based on the new advancing care information program. Any penalties levied based on meaningful use attestations from this year would be assessed in 2018.

For now, only physician offices - not hospitals - are governed by MACRA rules. In addition, this program only applies to payments physicians receive from Medicare. Medicaid is not included.

MACRA consolidates three existing quality reporting programs, plus adds a new program, into a single quality system through the MIPS. This is a new program that combines parts of thall the following incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

  1. Physician Quality Reporting System (PQRS)
  2. Value Modifier (VM) or Value-based Payment Modifier
  3. Medicare Electronic Health Record (EHR) Meaningful use (MU)
  4. Clinical practice improvement activities (CPIA)





MACRA Penalties

Medicare payments or penalties under MACRA being handed out starting in 2019. But the challenge for providers is that the Centers for Medicare and Medicaid Services (CMS) plans to use data collected in 2017 to determine payment adjustments for 2019.

Further complicating things for physicians is that under MACRA, physicians must choose between two distinct paths toward payment. Either the merit-based incentive payment system (MIPS) or an advanced alternative payment model (APM).

Most eligible professionals will probably report through the Merit-based Incentive Payment Program (MIPS) in the first year of the program. That data will then be used by CMS to determine which providers met the requirements for the APM track. Physicians are not locked into their choice—they can switch between MIPS and APM annually.




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