The US healthcare system is rapidly evolving from fee-for-service payments toward value-based reimbursement. This change is being driven in large part by the Centers for Medicare and Medicaid Services (CMS) in response to unsustainable growth in the expense of healthcare combined with a perceived lack of quality in the outcomes that the healthcare system has produced. One of the largest divers of change is the Medicare Access and CHIP Reauthorization Act (MACRA), which is scheduled to begin in January 2017.
MACRA will dramatically change how physicians and other healthcare providers are reimbursed for the care they deliver. Unfortunately, a recent survey of US physicians from Deloitte indicates that over 80% of physicians had no substantial knowledge of the rules of this legislation or how it would impact their practice.1 CMS Acting Administrator Andy Slavitt recently announced three new developments to MACRA. These changes are important for physicians and other healthcare providers to understand.
First, CMS will release the final rules for MACRA in November. These rules will detail what quality data physicians should collect and how this data should be reported. CMS anticipates that small and medium-sized physician practices will have a more difficult time complying with the reporting requirements compared to larger groups with access to more robust Electronic Health Record (EHR) systems and support staff to help collect and report data.3,4
Second, CMS has recently indicated that there will be a significant change to the original proposed reporting requirements for the MACRA Quality Payment Program (QPP). In response to concerns that implementation of the QPP may pose a burden on many providers, CMS has created four options for Quality Payment Program reporting4:
- Test the Quality Payment Program. This option allows physician groups to avoid penalties as long as they demonstrate that they can submit some data to the Quality Payment Program.
- Partial participation. This option allows for groups to submit data for part of 2017 to avoid a penalty and qualify for a small bonus payment.
- Full participation. This option allows groups that are prepared to fully participate in the Quality Payment Program to submit complete data for the entire calendar year and be eligible for a greater positive payment adjustment.
- Participation in an Alternative Payment Model. CMS estimates that less than 10% of groups will be eligible for this option, but those that are may receive a significant positive payment adjustment.
The details of participation in these options will be contained in the final rules, and every physician group will need to carefully consider which option best suits their practice.
Finally, this month CMS will be releasing 2015 Quality Resource and Use Reports (QRUR) for every physician group. QRURs provide crucial details of a group’s performance on both cost and quality metrics in 2015 and whether the group will receive positive payment adjustments (bonuses) or negative payment adjustments (penalties) in 2017. This report is also an invaluable guide for physicians on how to participate in MACRA in 2017, or whether they are prepared to participate at all.
Encompass Medical Partners can provide expertise for physicians on how to be successful in quality data collection, reporting, and using quality data to improve patient care.
- Help groups access and analyze their Quality Resource and Use Report.
- Understand the rules of participation in MACRA.
- Evaluate a group’s readiness to collect and submit quality data to CMS.
- Determine the best method of participation in MACRA and make specific recommendations on how to best prepare for success in 2017.
Please contact us for an initial consultation to determine how we can help your group not just survive, but thrive in the 2017 healthcare payment system.