COMMENTARY

How Physicians Can Get Started With MACRA

David O. Barbe, MD, MHA

Disclosures

September 19, 2017

The Medical Profession Is Changing

As physicians, residents, and medical students shape and navigate changes in the profession, the American Medical Association (AMA) listens, supports, and empowers them to succeed throughout their unique journeys. We know that red tape can be confounding, and that technology and a lack of interoperability can be frustrating. And those inefficiencies too often get between physicians and their true life's mission: caring for patients.

The shift to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and the Quality Payment Program (QPP) is the most significant change to Medicare's physician payment system in a generation.

The AMA's response is designed to help physicians meet the enormity of that challenge.

We have been working on two fronts: to modify the new regulations where necessary to lessen the regulatory burden, and to help physicians navigate and prepare for this change within their practice.

Of course, the journey to this point begins with the successful effort in 2015 to repeal the Sustainable Growth Rate (SGR) formula that we fought every year for over a decade to avoiddouble-digit payment cuts in the face of rising practice costs.

The new system enacted by Congress under MACRA eliminated the SGR threat and promises to be a platform for a transition to a more rational approach to value-based payment.

We worked closely with the Centers for Medicare & Medicaid Services (CMS) to ensure that the regulations implementing the QPP would be less onerous, provide lower penalties and an opportunity for upside incentive, and include a workable transition for physicians. Our advocacy efforts paid off when CMS adopted a majority of the AMA's recommendations in its Final Rule. The Final Rule:

  • Provides a longer transition period to prepare for the QPP;

  • Simplifies the MIPS program and reduces the reporting burden;

  • Increases the low volume threshold for MIPS reporting;

  • Gives more relief for small and rural practices;

  • Expands opportunities for alternative payment models (APMs); and

  • Offers a chance to avoid penalties.

One of our most important advocacy "wins" was the "Pick your Pace" reporting approach, which exempts physicians from a 4% penalty. All you have to do is report on a single measure, for a single patient, this year.

The only way to receive a penalty this first year is by not participating at all.

One patient. One measure. No penalty.

Physicians Are Still Uncertain About MACRA

A recent AMA/KPMG survey found that fewer than 1 in 4 of us feel prepared to meet the new MACRA requirements.

Although MACRA QPP is much better than the old SGR and the uncoordinated and punitive payment programs, it is still complicated, and physicians are concerned about how to be successful under a new program.

That's why the AMA has worked hard to develop timely, relevant tools and resources to help with your successful transition to the new MACRA/QPP. Visit ama-assn.org/MACRA. You'll find:

  • A short video offering step-by-step instructions on how to report this year, in order to avoid the penalty;

  • A tool called the Payment Model Evaluator, which will help you decide which payment model—either MIPS or an APM—is best for your practice;

  • A MIPS Action Plan to help physicians measure their progress in meeting requirements of the program and CMS deadlines; and

  • STEPSForward, which is a series of interactive modules that we developed to address a wide variety of practice challenges, including those related to value-based care.

At ama-assn.org/MACRA, you'll find these tools and other valuable information you need to get ready for this generational change. At the AMA, we are providing the resources you need to support you now, right when you need it. Thank you very much.

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