Understanding MACRA – We Can Help

The Medicare Access and CHIP Reauthorization Act of 2015 – MACRA – is a massive piece of legislation that eliminated the Sustainable Growth Rate (SGR) formula, and set the stage for how doctors would be reimbursed under Medicare into the future. The North Carolina Medical Society (NCMS) is gearing up to educate our members on what MACRA will mean for them and their practices.

The Centers for Medicare and Medicaid Services (CMS) contend that MACRA will streamline quality reporting systems (e.g. the meaningful use program) and simplify the transition to value-based care. Physician groups have been skeptical of these claims, saying they are just as complicated as the programs they replace and will put an undue burden on small and solo practitioners.

MACRA sets out a detailed timeline for implementation and fee updates based on type of practice and quality scores earned under the Merit-Based Incentive Payment System (MIPS). As of 2019, MIPS combines existing Medicare quality reporting programs like the Physician Quality Reporting System (PQRS), meaningful use of electronic health records and the value-based payment modifier into a single MIPS score. This score would determine bonuses or penalties capped at a total of 9 percent of total Medicare fee-for-service payments. Practices that participate in risk-based or advanced alternative payment models could earn a lump sum bonus of 5 percent.

Many resources are available to explain what is contained in MACRA including the AMA’s website and CMS’ site. Information on several upcoming CMS webinars on MACRA are included in the Learning Opportunities section of this Bulletin.

The AMA, the NCMS and organized medicine as a whole are sorting through the many complex details of the legislation and are pushing to ensure that physicians do indeed remain in control over the quality metrics on which they will be assessed. The goal is to ensure that quality metrics capture those activities under the physician’s control and that have been shown to truly improve quality of care, enhance access to care and/or reduce the cost of care. Another goal is to allow physicians enough time to transition to value-based arrangements without financial damage to their practice.

Watch the Bulletin for ongoing educational resources and information on MACRA, and what we are doing to advocate for necessary changes in the law on your behalf.

 
 

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