There is no denying that the past few years have been a time of immense change in healthcare. Sweeping pieces of legislation have fundamentally altered the way we practice medicine. This is absolutely the case when it comes to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA, for short). MACRA is an enormous piece of legislation signed into law in April 2015. The bill gained immediate notoriety because it killed the Medicare sustainable growth rate (SGR) formula—an oft-criticized, nearly 20-year-old system used to calculate physician payment reductions. Congress’ rare act of bipartisanship was a victory for rheumatologists; lawmakers not only eradicated a proposed double-digit pay cut, they also opened up new roads to long-term financial stability for physicians.
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However, the so-called permanent doc fix is anything but simple. From my perspective, MACRA is actually a bigger change to the overall healthcare landscape than even the Affordable Care Act. This is because the legislation largely reworks how doctors are reimbursed by Medicare. It also demands new, active engagement and decision making on the part of providers. For this reason, MACRA must be on every rheumatologist’s radar. It certainly is on the radar of our leadership team at the American College of Rheumatology and, as such, we will take an active role in assisting member rheumatologists in the transition to a new era of physician payments.
Before delving into the details of MACRA—as well as the choices that lie ahead for rheumatologists—I want to clearly establish what I hope readers will take away from this column.
First, time is of the essence: There is a very real deadline on Jan. 1, 2017. This is the date that data from your practice will start counting for Medicare reimbursement in 2019. This means that the time to start thinking about MACRA is right now.
Second, all providers will have to choose one of two payment tracks: Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).
Third, the ACR and its electronic patient-data reporting system, Rheumatology Informatics System for Effectiveness (RISE) Registry, will be an increasingly important resource in the months ahead, especially for those who select the MIPS track. And finally, it is imperative that the rheumatology community understand the impending long-term effects of MACRA and engage in strategic thought about the best option for their practice. I want to remind you that the ACR will be there, providing up-to-date information and support for its members.
Choose Your Own Adventure: MIPS vs. APMs
MACRA not only eliminated SGR, it also replaced it with an alternative set of predictable, annual, baseline payment increases and two potential payment tracks from which all providers must choose. Both payment models fit into the Centers for Medicare and Medicaid Services’ (CMS’s) larger goal of paying for value, rather than fee for service. What exactly does this mean? Well, all the way through 2019, there will be an annual baseline payment increase of 0.5%. From that point on, annual automatic increases come to an end, and physicians will have to choose their own adventure when it comes to Medicare reimbursement. Almost without exception, every Medicare provider in the country will be forced into one of these two pathways.