ACP Tells Internists to Be Prepared for New Payment Systems

Miriam E. Tucker

May 07, 2016

WASHINGTON, DC — A list of the top 10 things internists can do to prepare for the new Medicare payment systems has been developed by the American College of Physicians (ACP).

Number one on the list is a recommendation that physicians familiarize themselves with the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

"Making a change of this magnitude to Medicare to streamline and simplify is actually very complicated. It's overwhelming, even for CMS," Shari Erickson, MPH, vice president of governmental and regulatory affairs at the ACP, said during a press briefing here at ACP Internal Medicine 2016.

"We have to inform our members in bite-sized fashion. This top 10 list will help no matter how the rules come out in final form," she explained.

MACRA, signed into law in April 2015, repealed the sustainable growth rate formula that had been used to calculate Medicare payments to physicians and that had resulted in repeated threats of severe payment cuts, as reported by Medscape Medical News. The new law aims to move the basis of the payment system from volume to value.

Starting in 2019, physicians can participate in either the Merit-based Incentive Payment System (MIPS) or an Alternative Payment Model (APM) to earn increases in their Medicare payments. The measurement and reporting periods for the new systems could start as early as 2017, but the exact timing is still in play. Details of MACRA are available on the ACP website.

Under MACRA, three individual quality and value programs — the Physician Quality Reporting Program (PQRS), the Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record Incentive Program (meaningful use) — will be streamlined into the single MIPS program.

Panelists discussed the ways MACRA will affect physicians and patients during the press briefing.

"I do think MACRA holds the hope of decreasing many of the frustrations of the regulatory and reporting burdens we currently have," said Robert McLean, MD, who is a member of the ACP Board of Regents. "If implemented carefully and correctly, it could really provide the promise of alleviating some of the factors that lead to physician burnout."

The more rational and simplified rules of the Advancing Care Information program, successor to the Meaningful Use program, could lead to better and more meaningful documentation than we have now, he added.

"The current inefficiencies of electronic health records are largely due to many of the rules of Meaningful Use, so simplification of the reporting rules will hopefully be very helpful," Dr McLean explained.

Other items on the top 10 list include meeting current CMS objectives for meaningful use to qualify for the Electronic Health Record Incentive Program and participating in PQRS.

Although both programs are being replaced, "the changes won't all happen right away," said Erickson.

"The experience of reporting PQRS will be very helpful in the MIPS program," she added. To help with this, the ACP offers a member discount on a tool called the PQRSwizard.

Also on the top 10 list is reviewing Quality and Resource Use Reports. "It's important to understand where you stand on those. Take a look now and see how you're doing," Erickson said.

And, although currently required only for larger practices, the ACP recommends using a CMS-certified vendor to collect Consumer Assessment of Healthcare Providers and Systems survey data.

"You have to anticipate," she explained. "The more you begin to do now, the better."

This includes understanding and implementing a patient-centered medical home and implementing the ACP High Value Care recommendations. "This is going to help you no matter where you land," said Erickson.

"Big practices with robust electronic health records are already doing a lot on the top 10 list. They're already reporting PQRS, ensuring that Meaningful Use metrics are being met, and using registries in population health management," Dr McLean told Medscape Medical News.

"The bigger the healthcare delivery system or group, the more some of the behind-the-scenes work is out of sight to the practicing physician. That is clearly the case with the Northeast Medical Group in the Yale New Haven Health System, where I practice," he said.

Small practices, in contrast, are not always set up to do the necessary large data analyses. For those, Erickson advised, "one of the key things is to start to understand it. It is complex and will become more complex as we move toward implementation, but if you can start to do the items on the top 10 list that we've come up with — maybe not all at once, just identify a couple to start now — you can make progress."

Dr McLean and Ms Erickson have disclosed no relevant financial relationships.

American College of Physicians (ACP) Internal Medicine 2016. Presented May 5, 2016.

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