As the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is implemented in January with new models for quality-based reimbursement payments, rheumatologists must seize control of how they will be paid now—and in the future. This message was stressed by speakers during Holy MACRA! How to Survive and Thrive in the Era of MACRA, MIPS, and APMs, an informational session held on Nov. 13 at the 2016 ACR/ARHP Annual Meeting in Washington, D.C.
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A Step in the Right Direction
MACRA repackages some existing, incentive-based quality payment programs, such as Meaningful Use, said William F. Harvey, MD, MSc, FACR, clinical director of the Arthritis Treatment Center at Tufts University Medical Center in Boston and a member of the ACR Board of Directors.
“While not ideal, this is certainly a step in the right direction,” said Dr. Harvey. The ACR provides education to members about MACRA reporting options, and the Rheumatology Informatics System for Effectiveness (RISE) [Registry], a free, qualified clinical data registry, allows users to immediately earn points for
improved payment scores, he said.
MIPS Now, APMs Later
The Centers for Medicare and Medicaid Services (CMS) offers physicians the choice of two quality reporting pathways: participation in 1) the Merit-Based Incentive Payment Systems (MIPS) or 2) an Advanced Alternative Payment Method (APM). Most rheumatology practices will likely choose the fee-for-service MIPS track now, but CMS will continue to steer providers toward APMs in the future, said Dr. Harvey.
“Although the payment adjustments in the MIPS pathway start in 2019, the performance period for which you will collect and submit data that determine your 2019 payment adjustment starts on Jan. 1, 2017. So you need to be prepared. It’s urgent that you start thinking about this now, whether you’re an employed physician or not. This will affect you,” he said.
MACRA is budget neutral. Reimbursement money will be divided among participants on the basis of their scoring percentile, and a threshold score will divide providers who receive negative payment adjustments and those who receive positive adjustments, he said.
MIPS: Report & Score
MIPS gives providers a score of 0 to 100 points based on their reported activities in Quality, Resource Use, Clinical Practice Improvement Activities, and Advancing Care Information, which replaces Meaningful Use. The positive payment threshold for the 2017 performance period is only three points out of 100, Dr. Harvey said. He emphasized that in response to requests from the ACR and others for more flexibility early in the program, rheumatologists can submit any single data item to avoid a negative adjustment for the first year. Providers who score 70 or more points will qualify for a pool of high-performance threshold money.