Run a MACRA Test on Your Practice, AMA Says

October 07, 2016

The American Medical Association (AMA) earlier this week introduced free online tools to help individual physicians understand how Medicare's new payment system will impact their practice next year, and how to earn a bonus instead of a penalty in 2019.

To tap into this wisdom, physicians first answer a few questions about their practice, the reimbursement they receive from Medicare, and their participation in its incentive programs. All physicians and their practice administrators, and not just AMA members, can access the tools, although they need to create a free account on the AMA website and log in.

It's badly needed tutoring for a profession about to get hit next year by a sea change in Medicare reimbursement as big as a hurricane. Roughly 56% of physicians say they are somewhat or very unfamiliar with the Medicare Accountability and CHIP Reauthorization Act (MACRA), the 2015 law that shifts reimbursement from fee-for-service (FFS) to pay-for-value, according to a recent survey by the recruiting firm Merritt Hawkins.

Then again, who has time to wade through almost 1000 pages of proposed regulations implementing MACRA, or learn a fresh crop of acronyms? With its new online resources, the AMA is trying to simplify the subject.

The new reimbursement system, dubbed the Quality Payment Program (QPP), debuts in 2017. How physicians perform that year will determine whether they receive bonuses or penalties beginning in 2019.

The QPP has two payment tracks. The default track is the Merit-Based Incentive Payment System (MIPS), which combines the incentive program for meaningful use of electronic health records (EHRs), the Value-Based Payment Modifier, and the Physician Quality Reporting System. MIPS bonuses and penalties initially will be as high or low as 4% percent of Medicare FFS revenue and increase to 9% in 2022 and beyond.

The other track is the Advanced Alternative Payment Models (Advanced APMs). These APMs earn an annual lump-sum bonus of 5% as long as they assume significant financial risk under their particular model, such as a next-generation accountable care organization.

Having heard complaints that many physicians aren't ready to dive into MACRA next year, the Centers for Medicare & Medicaid Services (CMS) last month announced that all they need to do to avoid a MIPS penalty is get their toes wet. They have the option of reporting performance data for a full year to be eligible for a full bonus, reporting it for part of the year for a smaller bonus, or merely reporting data on a test basis for no bonus. The fourth option is joining an Advanced APM. By choosing any of these options, a physician will avoid a penalty in 2019.

Baby Steps Toward MACRA

The AMA's new online tools on MACRA walk physicians through all the details. Based on the data they enter, the so-called AMA Payment Model Evaluator projects whether physicians will default to the MIPS program, estimates how large of a bonus or penalty they will receive in 2019, and points them to educational resources. The AMA will update the evaluator tool once CMS issues a final version of its MACRA regulations, expected later this fall.

The AMA also has added MACRA-specific modules to a website called AMA Steps Forward, which is devoted to the science and art of practice improvement. The materials there, according to the AMA, will help physicians master MACRA when it comes to preparing for value-based care, selecting and implementing an EHR, reporting quality data, and practicing team-based care.

At a press conference on October 5, AMA President Andrew Gurman, MD, said some modules could satisfy practice-improvement requirements in MIPS.

Finally, the AMA is offering a podcast series on ReachMD titled Inside Medicare's New Payment System. Speakers include none other than CMS Administrator Andy Slavitt. Future episodes will keep physicians apprised of changes to MACRA as the program goes forward.

All these MACRA resources from the AMA, and others, are available on the association's website.

Follow Robert Lowes on Twitter @LowesRobert

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