CMS Provides MACRA Support for Clinicians In Need

February 28th, 2017 - By Apoorva Anupindi

The Quality Payment Program (QPP) reporting period, a part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), officially began on January 1st, 2017. Providers have between now and October 1st to begin their quality reporting for MACRA in order to ensure they won’t receive negative payment adjustments in 2019.

Though MACRA has the best of intentions in implementing a value-based care system, it has been met with a level of uncertainty. This comes particularly from smaller practices that may not have the proper support and resources for such an undertaking. A Deloitte survey reported that 50% of physicians had never heard of MACRA. 32% recognized the name but did not know of the requirements of the law. 58% said they would choose to participate in larger organizations to minimize individual financial risk and gain access to resources for MACRA.

MACRA for Providers

Steps have been taken, however, to help individuals and small practices better prepare for the requirements. There is a low-volume threshold for the program, which is designed to protect smaller practices from facing potential penalties. In order to be eligible for the QPP, providers need to bill more than $30,000 with Medicare Part B and must have more than 100 Medicare patients each year.

The Centers for Medicare and Medicaid Services (CMS) also announced last week that they would give $20 million dollars to 11 community-based organizations in efforts to providing small practices with more training and resources regarding the QPP. CMS plans to invest at least $100 million over the course of 5 years in support of this program. In addition, the Department of Health and Human Services (HHS) announced last year they will offer $100 million in funding over 5 years to prepare small practices, especially in rural and underserved areas.

For those who don’t know, there will be two paths for providers and hospitals to choose from: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). CMS is offering four different MIPS participation options to allow providers to “pick their pace”:

  1. Test the program
  2. Participate in part of the calendar year
  3. Participate for the full calendar year
  4. Participate in an Alternative Payment Model in 2017

Providers who see 20% of their Medicare patients or receive 25% of their Medicare payments through an Advanced APM will earn 5% incentive payments in 2019 for “taking on some risk related to their patients’ outcomes”, according to the Quality Payment Program website.

Why Value-Based Care?

A value-based payment model emphasizes paying providers based on the quality of patient care rather than the number of patients they see (fee-for-service). Some of the benefits of this model include:

  • Efficient patient cycles
  • Better patient experience
  • Cost-effective treatment

While providers are hesitant about the program, CMS is making several efforts to ensure a smooth transition. Restructuring the current payment model and implementing a value-based care system is in the best interest of the healthcare industry, emphasizing the importance of patient care.

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