MACRA

[GXA]

Has anyone looked into the new MACRA payment guidelines for physicians?

The measurement period starts January 1, 2017, and payment will be affected beginning January 1, 2019.

There are new acronyms (APM and MIPS), and an extremely complex algorithm to determine which categories to select.  I bet the consultants will have lots of work helping large systems decide which categories to select.

Given the complexity involved, my question for the group is how does an independent physician figure this stuff out?  I suspect they will either lose money on this, become employed/join a larger group, or quit seeing medicare patients.

[Rando]

The final MACRA guidelines are scheduled to be released at the end of October, so the final specifics aren't available right now.  Since physicians are supposed to start implementing them at the start of 2017, that only leaves 2 months to learn and apply them.  If you look at websites like Modern Medicine or Medical Economics you can find some general information.

 

I've been following this pretty closely.  I wrote some comments during the public commenting period on MACRA and sent copies to my senators and congressman.  Both senators offices ended up talking with me on the phone and one had my comments read into the Congressional Record.  There was a Senate hearing a couple of weeks ago with the acting head of CMS which you can actually watch on line.

 

One of the concerns is that the CMS' own numbers predict 87% of solo physicians will fail to meet the need MIPS guidelines and get a penalty.  For groups 2-9 the numbers are only a little better.  Only about 4% of physicians will be in the APM track so the MIPS is probably what you should be looking at.

 

The way the law is set up this section of MACRA is supposed to be budget neutral.  That means the penalties will fund the bonuses, effectively taking money from small groups and giving it to large groups who are in a much better position to meet the guidelines.  Large groups can just hire somebody to learn all this stuff and take care of it, while as you note in your post independent physicians usually have to do it by themselves.

 

The penalizing of solo and small groups is what's making some politicians take notice.  The CMS director promises they will help small practices but if you've ever dealt with CMS before I wouldn't be holding your breath.  My gut feeling is it's probably going to be delayed as the 2 months just isn't enough for anybody to get on board with this, and I am hoping some allowances will be made for small practices.

 

Anyway that's probably more than you wanted to know.  I will be watching this closely and like I said Modern Medicine and Medical Economics are good sites to follow this stuff.  The websites will have the info way ahead of the paper magazines.

[RetiredERdoc]

Glad I am retired and don't have to worry about this. It is interesting to look at KevinMD and see posts with the title of : How Macra will decimate the private practice physician, alongside "Why doctors shouldn't worry about Macra".

[Osiris]

I joined Privia and  I am an optimist and I expect to do well.

I do believe there is a better mouse trap and I hope I chose well.

[Rando]

http://medicaleconomics.modernmedicine.com/medical-economics/news/mips-explained-4-categories-physicians-must-master

[Hatton]

Frightening article Rando

[Rando]

https://blog.cms.gov/2016/09/08/QualityPaymentProgram-PickYourPace/

 

Looks like they are giving a few options.  As long as you submit some data in 2017 your won't get a penalty.  To get any bonuses you'll have to jump through more hoops.

[Docbeans]

Rando wrote:

https://blog.cms.gov/2016/09/08/QualityPaymentProgram-PickYourPace/

 

Looks like they are giving a few options.  As long as you submit some data in 2017 your won’t get a penalty.  To get any bonuses you’ll have to jump through more hoops.

Click to expand...

On a related note, on Medscape: New MACRA Rules make Medicare pay cuts unlikely in 2019.

[DarrVao777]

Couple more years to save, save, save

[Docbeans]

Is anyone here in pvt practice hiring consultants to guide them through the process?

[Hatton]

Be careful with consultants.  They can run up your costs.  Most of this stuff seems terrible but blows over.  Remember icd10.

[Docbeans]

hatton1 wrote:

Be careful with consultants.  They can run up your costs.  Most of this stuff seems terrible but blows over.  Remember icd10.

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Absolutely, it's a huge overhead. But its scary too, considering CMS is predicting that most practitioners less than 24 member strong, will be paying the penalty. And that is 9% at max!! Hopefully, there will be changes along the ways and a softening of the blow.

[Hatton]

Hopefully there will be changes and delays.  Medicine seems to panic about every rule change then it happens and looking back it was no big deal.  Your hospital will probably have some free or low priced seminar as the law gets closer.  This yet another example of why people get so burned out throw in the towel and work for a hospital.

[Rando]

hatton1 wrote:

Hopefully there will be changes and delays.  Medicine seems to panic about every rule change then it happens and looking back it was no big deal.  Your hospital will probably have some free or low priced seminar as the law gets closer.  This yet another example of why people get so burned out throw in the towel and work for a hospital.

Click to expand...

I have to disagree with you a bit - sometimes it is a big deal.  ICD-10 was fairly benign, but Meaningful Use has harmed some practices.  The benefits of the EMR and other MU requirements generally have not warranted the increased overhead.  Many practices have been audited and had to pay back their MU bonuses.  Since you had to hit 100% of the requirements to get the bonus it's fairly simple for the auditors to find one problem and ding the physician for the entire payment.  These programs are put together by people with little idea of what happens in a small practice, and it shows.

 

In my town there are only a handful of independent physicians and it's very unlikely the hospital will have any programs to help us.  They certainly haven't in the past.

[Rando]

OK CMS has released the final guidelines for 2017.  They also rolled out a new website   https://qpp.cms.gov/   which is much more user-friendly than their old site.  That's not saying much since their old site was terrible but it is a big improvement.

 

Basically you can make a token attempt to participate in MIPS and will get no penalty, you can participate for 3 months and maybe get a small bonus, or participate all year and possibly get a large bonus.  Rather than me try to go through everything it's easier just to go to the website.

 

They also expanded the number of physicians that can opt out of MIPS completely.  If you don't collect much from Medicare or see many Medicare patients it's now easier to opt out.