Issue link: https://beckershealthcare.uberflip.com/i/674245
48 FINANCE MACRA Roadmap: 9 Questions on a Post-SGR World, Answered L ast April, to the relief of many providers, Congress passed the permanent "doc-fix" to repeal the flawed sustainable growth rate formula that determined Medicare physician fees. It was replaced with legislation — the Medicare Access and CHIP Reauthorization Act, or MACRA — that promises to pay physicians for value over vol- ume in a way that jells with the goals of individual medical practices and patient-centered care. "It's unique — it enjoys strong bipartisan support, unlike other health- care proposals in the past few years," says Igor Belokrinitsky, partner at PwC Strategy&. "CMS is really taking the lead in transforming health- care in a way that helps stakeholders, as opposed to kicking the can down the road." Comments from CMS Acting Administrator Andy Slavitt indicate the administration is truly trying to get it right this time. "e stakes are high for this program. As any physician will tell you, physician bur- den and frustration levels are real," Mr. Slavitt said in January at the J.P. Morgan Annual Health Care Conference. "Programs designed to improve oen distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that people who build these programs just don't get it." MACRA is set to roll out in 2019, but 2017 could mark the start of per- formance measurements that will determine reimbursement in 2019. For physician practices that have been sitting back — it's time to assem- ble a preparation plan and put it in motion. Here are answers to nine questions on MACRA basics. 1. What does MACRA entail? At its simplest, MACRA makes three major changes to Medicare reim- bursements. First, it ends the SGR formula. Second, in its place it estab- lishes a new framework to reward physicians based on performance and health outcomes other than volume. Lastly, it aims to combine existing quality reporting programs into one streamlined system. As part of this, it establishes an annual phy- sician fee schedule update of 0.5 percent from 2016 to 2019. Aer that, the Medicare physician fee schedule will remain at 2019 levels through 2025. Beginning in 2019, qualified physicians and physician groups will opt to enter one of two new tracks for payment: the Merit-based Incentive Pay- ment System or Alternative Payment Mod- els. However, Rivka Friedman, practice manag- er of research and insights at e Advisory Board Company cautions providers that MACRA will not be a panacea for low re- imbursements. "e biggest thing we have been telling providers is while SGR wasn't a wonderful architecture for payments, MA- CRA doesn't provide all that much relief in how much increase in payments providers will see," says Ms. Friedman. 2. How will physicians get paid under MIPS? MIPS will likely be the preferred choice of the two programs due to its familiarity, according to Mr. Belokrinitsky. Under this program, CMS is taking an incremental approach to linking fee-for-service payments to quality and value. MIPS will subsume the Physician Quality Reporting System, the Value-based Payment Modifier and the Medicare Electronic Health Record incentive program for eligible providers. ese payment adjustments will be rolled into one program with four categories: quality, resource use, clinical practice improvement and meaningful use of EHRs. Clinicians' performance in each category will be compiled into a composite performance score that will ulti- mately determine their payment adjustment. Composite scores above or below the mean will translate into positive or negative payment ad- justments to the base rate of Medicare Part B payments accordingly. e potential maximum adjustment increases each year from 2019 to 2022, when the maximum adjustment is a gain or loss of 9 percent. To keep MACRA budget neutral, it will allow the positive adjustment to be scaled up to three times greater. is means the swing — how much a provider can lose or gain under MIPS — ranges from gains of up to 27 percent to losses of up to 9 per- cent on payment adjustments by 2022, according to Ms. Friedman. What makes MIPS unique from prior programs is providers whose composite score is at the threshold will not have payment adjusted at all. is effectively eliminates the pass-fail, all-or-nothing approach of the old payment adjustments, as American Medical Association Board Chair Stephen Permut, MD, notes. "Under the MIPS, the aggregate fi- nancial risk is less than under the previous Medicare quality and report- ing programs," Dr. Permut wrote in an AMA blog. e MIPS program may feel safer because it eliminates the pass-fail ap- proach to payment adjustments and because providers are already fa- miliar with the payment adjustment systems that make its foundation, but physicians should note lower risk does not necessarily make for "The biggest thing we have been telling providers is while SGR wasn't a wonderful architecture for payments, MACRA doesn't provide all that much relief in how much increase in payments providers will see." —Rivka Friedman, practice manager of research and insights, The Advisory Board Company