Is Your Nephrology Practice Prepared for MACRA/MIPS?

Is Your Nephrology Practice Prepared for MACRA/MIPS?
MACRA replaces the 1997 Balanced Budget Act's SGR that was used to determine annual physician payment updates. After approximately 20 so called "doc fixes," MACRA was passed to replace the SGR in part because the formula neither addressed service frequency and intensity nor quality improvement.

MACRA Passed with over 90% Congressional support on April 16, 2015
MACRA Title I replaces SGR formula annual physician update methodology
The new law establishes a 0.5% annual physician fee update from 2015 through 2019
Beginning in 2019 the annual physician fee update will be calculated using one of two payment methods:

Merit-based Incentive Payment System (MIPS): +/- Payment Adjustment
Alternative Payment Models (APMs): 5% Bonus for qualifying participants in an advanced APM
There is a tremendous amount at stake. MIPS is expected to impact as many as 750,000 providers, with up to 90,000 impacted by the APM provisions. Medicare anticipates that $833 million will be taken from groups through penalties and re-distributed to others through incentive payments (budget neutrality is retained). Furthermore, $500 million has been earmarked for “exceptional performance payments.” Payments to APMs are expected to total between $150 and $450 million.

Who is affected?

The new payment models will affect more than 600,000 eligible providers, according to CMS.

Eligible providers include those who annually bill Medicare for more than $30,000 or care for more than 100 Medicare beneficiaries. CMS increased the thresholds from those included in its proposed rule as a way to exempt more small practices from the requirements.

Eligible providers who will be subject to the requirements are certified registered nurse anesthetists, clinical nurses specialists, nurse practitioners, physicians, and physician assistants.

CMS said 2017 is a "transition" year for the program. Providers who are ready to begin participating in the programs can start collecting performance data on Jan. 1, 2017. Providers who are not yet prepared to participate have until Oct. 2, 2017, to begin collecting performance data. Participating providers must submit all data, regardless of when collection began, to CMS by March 31, 2018.

The first payment adjustments under the programs will take effect Jan. 1, 2019, and will incorporate 2017 data. CMS said it will continue to collect provider feedback during that time and expects "the Quality Payment Program to evolve over multiple years in order to achieve our national goals."

Tower Physicians Solutions can provide you with the resources needed to determine the best quality measures for you and your practice. We will determine which measures you are performing well in and create a strategy for how to meet other measures. Tower experts will help you become fully prepared for MACRA implementation.

There’s a lot to digest in this hefty rule and a great deal at stake, including hundreds of millions of dollars in penalties and incentives. If you have concerns, please contact us at Tower Physicians Solutions.
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