October 20, 2016
In our changing health care environment, it’s imperative for us to stay current. Our profession embraces innumerable acronyms, and today I want to ensure we are all up to speed on one that will fundamentally change how we provide care, MACRA. I met with Dr. Ryan Walsh, chief medical information officer, to provide us information on what these five letters mean to the present and future of healthcare.
Q: What is MACRA?
A: MACRA – the Medicare Access CHIP Reauthorization Act – repeals the Medicare sustainable growth rate methodology for updates to the physician fee schedule and replaces it with a new merit-based incentive payment system (MIPS). On Friday, Oct. 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule, 2,400 pages, implementing MACRA.
Q: What do our faculty, residents, and students need to know about this change in how Medicare payments are made?
A: The biggest thing that our faculty, residents, and students need to know is that this is not just another rule to change how we report data. This is a fundamental and seismic shift in how we will be paid that will develop and grow over time.
This is the government’s way of trying to change how we take care of patients through legislation and how they compensate us. Medicaid will likely do some similar things and so will commercial payers.
The next most important thing to know is…this isn’t going away. It doesn’t matter who wins the White House. This isn’t like HMO’s back in the 1980s and ’90s. The impact will grow over time.
Q: How will the change start to take shape?
A: Clinicians will have four reporting options during the first year of participation, which will be a transition year:
- Report Merit-based Incentive Payment Systems (MIPS) for a full 90-day period, or the full year to maximize the chances to qualify for a positive adjustment;
- Report MIPS for less than the full year but for a full 90-day period and report more than one quality measure, more than one improvement activity, or more than the required measured in advancing care information to avoid a negative adjustment and possibly receive a positive adjustment;
- Report one quality measure, one clinical improvement activity, or the required measures of advancing care information to avoid a negative adjustment; or
- Participate in Advanced Alternative Payment Models and qualify for a 5 percent bonus incentive payment.
UT Physicians will report as a group based on its Federal Tax ID numbers. We believe that due to our size, composition, and infrastructure that we’ll be able to report for a full year, or the 90-day period, depending on how CMS decides to structure the first year. It’s very nice though to have some flexibility in the event of unforeseen challenges. The transition year will allow us the ability to find solutions that work best for us as a group and cause the least impact to clinicians in the office and the doctor-patient relationship.
Q: How will it impact the way our physicians deliver care? What will change in their day-to-day practice?
A: The importance of thorough documentation and coding is going to be more and more important.
We will do our best to provide tools to our clinicians to help them with this and support them!
I think the things our clinicians will notice most is that we need to make sure we’re more accurately capturing what they do. The data will affect how they are paid, and it’s publicly reported for all to see.
Q: When does this go into effect and what do our providers need to do now to start getting ready?
A: The new rule goes into effect January 1, 2017. I think the best thing clinicians can start doing now is to focus on taking great care of their patients, and documenting it well.
I also need providers to engage by reading the updates we’ll send out and asking me questions! Knowledge is power.
Dr. Tom Murphy and I will be doing a “MACRA tour” to the departments and divisions in the coming months to really talk through the specifics.
Q: How will MACRA impact the physician-patient relationship?
A: I think the public nature of the data will affect the relationship. Your patients will be able to see your scores on cost and quality.
The next piece is that we need to consider how to better help our patients through case management and engaging them with primary care.
We aren’t any longer just responsible for their knee or eye or heart but for the entirety of their care. We need to work as a system to achieve this.
Q: Will this impact the payment system for other payers?
A: It’s very typical that CMS goes first, then Medicaid, then commercial payers. So, yes.
Thank you, Dr. Walsh, for this primer. I anticipate we will be hearing a lot more on this topic. Additional information on the final rule, including a Quality Payment Program fact sheet and executive summary, are online.
And as part of National Breast Cancer Awareness Month, everyone is invited to join UT Physicians in wearing pink on Friday, Oct. 21, which is also National Mammography Day.