After four years of work in Congress with bipartisan support, the Medicare Access and Chip Reauthorization Act (MACRA) was signed into law on April 16, 2015 and the official MACRA implementation began on January 1, 2017. Now, only a few months into the MACRA roll-out, the complexity of the programs and significant challenges are making it difficult for some providers to participate in MACRA implementation.

MACRA Implementation

MACRA Implementation has created specific hurdles that must be overcome to promote physician participation in the merit-based payment program

Let’s take a deeper dive into the MACRA legislation and analyze what were the primary goals of the program. We will also review the latest news articles that explain in detail the specific hindrances to meeting these goals; why providers should opt into MACRA; and what modifications may be in order.

Three Primary Goals of MACRA Implementation

Health Affairs reiterates the three fundamental goals of MACRA, which are:

  1. Repeal the Sustainable Growth Rate (SGR), which has caused instability and uncertainty for more than 10 years
  2. Stabilize physician payments which relieves providers from the frequent reimbursement cuts
  3. Move to a more stable payment system that won’t require policy marker updates every couple of years

Health Affairs reports in their article that the first goal has been met. The second goal has been partially met as payments have “technically stabilized”. The third goal is currently underway with MACRA implementation in full effect. The article drives home the stance that changes are needed in order to meet this third goal that involves the transition away from a fee-for-service (FFS) model into what is known as “alternative payment models” (APMs).

MACRA is attempting to solve these issues by increasingly making FFS more unappealing and implementing APMs that providers are able to transition to. According to Becker’s Hospital Review, two payment options comprise MACRA’s Quality Payment Program, which are the Merit-Based Incentive Payment System (MIPS), which is a complex pay-for-performance model, and an Advanced APM, that is currently not an option for most providers.

The problem?

“The main issue currently confronting providers in MACRA is that, despite considerable flexibility for 2017, when full implementation arrives, MIPS will make FFS untenable at a much faster pace than the development and implementation of viable APMs. This means that, unless something changes, a large number of providers will be pushed out of FFS and over the cliff before they have a safe place to land.” – John O’SheaHealth Affairs Blog

CMS Encouraged to Simplify MACRA to Improve Participation

Due to the confusing nature of the merit-based payment programs included in MACRA, some physicians are choosing to forego the program entirely and deal with the penalties. In fact, a physician was recently quoted in a MedCityNews article, stating that, “I am not participating in MIPS and plan to fully ignore MACRA, taking the maximum penalty. Wellness exams and CCM [Chronic Care Management] will more than make up for any potential penalties.”

At the beginning of this month (May of 2017), RevCycleIntelligence reported that the American Academy of Family Physicians (AAFP) urged the Centers for Meidcare & Medicaid Services (CMS) to make modifications to MACRA in order to simplify the implementation in order to encourage primary care provider participation in the Quality Payment Program.

Within their letter to CMS (PDF), according to the article. “The industry group called for several Quality Payment Program eliminations to reduce the administrative burden on primary care providers, such as the jettison of the Merit-Based Incentive Payment System (MIPS) alternative payment model (APM) track.”

While the agency has designed a modified MIPS reporting pathway for eligible clinicians in order to promote APM participation, AAFP argued that the middle-ground pathway was “incredibly confusing, and it may inadvertently incentivize physicians to remain in the fee-for-service program rather than continue their progress towards AAPMs [Advanced APMs].”

Providers Will Benefit to Get On Board with MIPS and APMs Now

Even though some providers are choosing to forego MACRA participation, the vast majority recognize the opportunity for increased payments. Eagle Consulting Partners recently reviewed Health Care in 2017, and they point out how much physicians could benefit from the program:

“Clinicians participating in Advanced APMs will see bonus lump some payments of 5% of their Medicare reimbursements as well as any additional payments they receive through their innovation model. Clinicians participating in MIPS could see a theoretical maximum 37% in increased Medicare reimbursements. If the MIPS program participation is anything like the Value-based Payment Modifier program, there is a good chance that early adopters could be big winners.”

At The SSI Group, many of our clients are healthcare providers. We will continue to monitor updates with MACRA as they develop, and keep our readers informed.