The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law on April 16, 2015. According to the Centers for Medicare & Medicaid Services (CMS), MACRA “advances a forward-looking, coordinated framework for clinicians to successfully take part in the Quality Payment Program that rewards value and outcomes in one of two ways:”
- Advanced Alternative Payment Models (Advanced APMs)
- Merit-based Incentive Payment System (MIPS).
In November 2017, CMS submitted a final rule for the Quality Payment Program (QPP) created under MACRA. In the content of that document, CMS stated that the QPP program “emphasizes high-value care and patient outcomes while minimizing the burden on eligible clinicians. The Quality Payment Program is also designed to be flexible, transparent, and structured to improve over time with input from clinicians, patients, and other stakeholders.”
In 2018, according to CMS, there are approximately 622,000 eligible clinicians who will be required to report under MIPS. An additional 540,000 clinicians are “expected to fall below revised low-volume exemption thresholds set forth in the new rule, which exclude clinicians and groups receiving less than $90,000 in Medicare Part B reimbursement or treating fewer than 200 Part B beneficiaries.”
Independent physicians who have been challenged by reporting requirements or waiting for MACRA updates will now have to act quickly so they can be fully prepared to report for the full year in 2018. For those physicians who are uncertain of the scoring categories, Physicians Practice reports that Cost has now been added, although at a reduced percentage, for MIPS scoring in 2018. Those scoring categories include:
- Quality (50 percent)
- Advancing Care Information (25 percent)
- Improvement Activities (15 percent)
- Cost (10 percent)
Additional considerations for independent physicians reporting on MACRA in 2018 include bonus points for treating patients with complex conditions and for smaller practices that submit data on at least one performance category. Independent physicians are also eligible to join virtual groups to participate in MIPS in 2018.