Brave New MACRA World

Sweeping changes in how physicians are paid for patient care are on the way. The Medicare Access and Children’s Health Insurance Program (CHIP) Reauthorization Act of 2015, or MACRA, tossed out the Sustainable Growth Rate formula and ties reimbursement to quality measures.

A Helpful Presentation
Because 2017 is the first performance year under the new laws, rheumatologists have numerous questions, concerns and opinions about how to adapt. To ease the transition to the new payment model, the 2016 ACR/ARHP Annual Meeting in Washington, D.C., will include a session called, Holy MACRA! How to Survive and Thrive in the New Era of MACRA, MIPS and APMs.

Speakers will include co-moderators William F. Harvey, MD, clinical director, Division of Rheumatology at Tufts Medical Center in Boston, and Douglas W. White, MD, a rheumatologist at Gundersen Health System

William F. Harvey, MD, clinical director, Division of Rheumatology at Tufts Medical Center in Boston.

in LaCrosse, Wis. Harold D. Miller, president and CEO of the Center for Healthcare Quality and Payment Reform in Pittsburgh, will round out the panel.

MACRA’s changes “are more impactful than even the Affordable Care Act. [MACRA] will fundamentally change how every rheumatologist is paid by Medicare,” says Dr. Harvey. He encourages meeting attendees to “hear the latest about this still-evolving program and understand how it will affect their practices.” In this session, attendees will learn “how to survive [under] the new pay-for-performance scheme and what to look for in an alternative payment model.”

MACRA will create a Quality Payment Program (QPP) to replace the SGR formula to determine Medicare payments. Providers will choose from one of two options: the Merit-Based Incentive Payment System (MIPS), in which providers will be scored on quality, resource use, clinical practice improvement and meaningful use of electronic health records (EHR); or eligible Alternative Payment Models (APMs), such as Accountable Care Organizations (ACOs).

Key Session Points & Objectives
Panelists will cover the following timely points:

• How physicians will be scored under MIPS;
• Who is excluded from the MIPS path and why;
• Quality measures that will apply to most rheumatologists;
• Strategies that will help rheumatologists avoid being assigned the highest costs within these programs; and
• APMs for rheumatologists who don’t want to transform their practices into ACOs.

The ACR raised concerns with the CMS that rheumatologists, particularly those in small and rural practices, need simple, transparent and tenable reporting requirements, and the flexibility of multiple options to transition smoothly to the first two years of the new payment system. In the final rule, released Oct. 14, the CMS did broaden exemptions from the program, which will help small practices that struggle with additional administrative work.