Back Understanding MACRA and the Rules of Medicare Physician Compensation - Part 2

Understanding MACRA and the Rules of Medicare Physician Compensation - Part 2

Here is part 2 of our series on understanding MACRA. To read part 1 click here.

MACRA decides Medicare compensation by letting physicians choose from two payment tracks: the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs).

The MIPS program combines quality and performance improvement programs “into a single performance program,” the AAFP explains. A physicians’ performance in four different categories (listed below) will determine his or her performance score and ultimate payment rate.

In the words of the CMS itself, physician payment adjustments are determined “based on evidence-based and practice-specific quality date.” This is done by showing that “you provided high quality, efficient care supported by technology by sending in information” in these categories:

Again per the AAFP, the CMS “estimates that more than 90% of MIPS-eligible clinicians will receive a positive or neutral payment adjustment” in the transition year of 2017. “Eligible clinicians who achieve a final performance score of 70 or higher will be eligible for a portion of the ‘exceptional performance adjustment,’ funded from a pool of $500 million.”

APMs, on the other hand, can be utilized by physicians who:

  • Make use of electronic health record (EHR) technology; 
  • Provide payment for covered professional services based on quality measures comparable to those used in MIPS’ quality category; and 
  • Either “be a Medical Home Model expanded under CMS Innovation Center authority, or require participating APM entities to bear more than a nominal amount of financial risk for monetary losses.”

“Physicians who provide care to Medicare patients through a recognized Advanced APM will be eligible for a 5% bonus payment,” the AAFP adds. “CMS estimates that 30,000 to 90,000 clinicians could be qualifying APM participants in 2017, and that approximately 25% of eligible Medicare clinicians could be in an Advanced APM by the second year of the program.”

There’s more to MACRA than these provisions, too: “The law also includes new funding for technical assistance to providers, funding for measure development and testing, it enables new programs and requirements for data sharing, and establishes new federal advisory groups,” the NRHI website adds. “It is comprehensive legislation that has the potential to significantly restructure US healthcare.”

In other words, there’s a lot to understand about MACRA. And there’s no avoiding it: as the NHRI points out, it’s “important to recognize the fact that the changes in MACRA are coming – like it or not.

“While it may be tempting to duck for cover, the best course of action is to learn all you can – and to determine how to be successful in the new environment.” The organization provides a rough guide to doing just that; we urge you to review it here. We also recommend reviewing The Advisory Board’s rundown of 25 key questions related to MACRA implementation.

Not keen on figuring out the ins and outs of Medicare compensation? There’s another option: We can connect you with a physician career opportunity that lets you prioritize caregiving over administrative affairs. If you’re interested in learning more about physician career opportunities, we encourage you to contact a Kendall & Davis representative today.