Clueless About MACRA?

The Medicare Access and CHIP Reauthorization Act (MACRA) goes into effect with a push toward value and quality on January 1, 2017.  The new Merit-Based Incentive Payment System (MIPS) helps to link fee-for-service payments to quality and value by “quality-tiering” practices based on scoring in four domains:

  1. Quality of Care (PQRS)
  2. Resource Use (Cost)
  3. Advancing Care Information (MU)
  4. Clinical Practice Improvement Activities (CPIA)

MIPS encompasses all physician practices that bill Medicare Part B FFS, including Medicare Shared Savings Program ACOs that are in Track One (1).  The law also provides incentives for participation in Alternative Payment Models (APMs) which are ACO or other models with risk (e.g., MSSP ACO Track 2 & 3, Next Generation and Pioneer ACOs). 

Medicare will use a practice’s quality scores in these four areas to adjust a practice’s FFS payments either positively and/or negatively.  Because the proposed MIPS program is budget neutral, all penalty dollars will be awarded to practices with the best performance; so, there is a tremendous potential for significant additional revenue for practices that implement a quality improvement strategy that includes the ability to successfully report the data.  * The 2016 PQRS program is also budget neutral with great potential for significant bonus dollars for practices in the top tier.

Though quality scores will account for 50% of the total MIPS score in 2017, that drops down to 30% in 2019.  The Resource Use (Cost) score is only 10% in 2017, but it increases significantly to 30% of the MIPS score in 2019.  Advancing Care Information (formerly MU) accounts for 25% and Clinical Practice Improvement accounts for 15% consistently from 2017 – 2019.

Bottom line, quality and cost account for 60% of a practice’s MIPS score; so, these two areas require special attention now in order to be successful in 2017.

** Track 1 MSSP ACOS will report under MIPS.

For more information on MIPS, 2016 PQRS reporting tips, tools and resources, please contact Christie Lawrence at 214-593-6926 or email christie.lawrence@kpnhealth.com