Sweeping changes are coming to how Medicare pays for physician services. The Medicare Access & CHIP Reauthorization Act of 2015, or MACRA, replaced the flawed sustainable growth rate formula with predictable payment increases. It also required the Centers for Medicare & Medicaid Services to implement a new two-track payment system — the Quality Payment Program — for physicians and other eligible clinicians. The law represents the next evolution in payment for value-based health care. While the new payments don’t begin until 2019, they will be based on clinicians’ performance beginning in 2017. This fall saw a flurry of activity around MACRA following the Oct. 14 release of the final rule implementing the changes. The rule presents challenges and opportunities for hospitals, health systems and the nearly 540,000 directly employed or contracted physicians with whom they partner to deliver quality care. Hospitals that employ physicians will help to defray the cost from implementation of and ongoing compliance with the new reporting requirements, as well as assume the risk for any payment adjustments.
Eligible clinicians will participate in one of two tracks starting in 2017 — the default Merit-based Incentive Payment System or Advanced Alternative Payment Models, such as an accountable care organization or patient-centered medical home.
Under MIPS, clinicians' performance will be measured on quality, clinical practice improvement activities and advance care information (formerly known as meaningful use of electronic health records). Starting in 2018, they also will be assessed on cost. They will earn rewards or penalties, based on performance. In contrast, the advanced APM track allows physicians who receive a significant portion of their payments through eligible APMs to be exempt from most MIPS quality reporting provisions and, through 2024, to receive a bonus of up to 5 percent. Eligible APMs must require use of certified EHR technology, tie provider payments to quality performance and hold participants accountable for paying back a portion of their losses to Medicare if their spending exceeds certain targets.
Hospitals and the clinical community share the same goal of making care safer and more efficient for patients, and already work toward this goal in countless ways. As hospitals continue to work more closely with clinicians, they need tools and resources to strengthen patient health outcomes, ensure financial stability and succeed as part of a truly coordinated system that enables clinicians to focus on patient care. The American Hospital Association is ready to support the needs of the health care field as we implement MACRA’s sweeping changes. We have a strong suite of resources for hospitals, physician and nurse leaders, other clinicians and trustees. Our webinars, MACRA Minutes video series, in-depth advisories and other resources are available at www.aha.org/MACRA. A toolkit that provides a deeper dive into many aspects of the new program, including quality reporting requirements and partnering with clinicians to promote value-based care, is also under development.
With 2017 just around the corner, hospitals and their clinician partners need to understand how to prepare for population health and how their current pop health and clinical activities align toward safer, better and smarter care. Watch for more information and tools in the coming weeks and months that will support the field through MACRA implementation. The AHA is your trusted voice, trusted resource and trusted partner. •
Jay Bhatt, D.O., is AHA senior vice president and chief medical officer and president of the Health Research & Educational Trust.