CMS-MEDICARE — MACRA, PQRS, VBPM, MU, MIPSI, etc.
My, oh my, you better learn your acronyms if you want to keep up. Hard to focus on what a provider and staff now must do or plan to do within the next few months. Here’s a short list:
MACRA (Medicare Access and chip Reauthorization Act of 2015) will definitely impact payments and create more and more overhead. The law will impact Medicare payments by: First, it repeals the SGR (sustainable growth rate) that had calculated payment cuts, then created a way to reward physicians for quality care by establishing payment tracks, merit-based MIPS and alternative payment models (APMs). To make it work, the PQRS (Physician Quality Reporting System),and the VBPM, Value-based Payment Modifier, and MU, Meaningful Use, and the CPIA, Clinical Practice Improvement Activities are to be integrated.
Got all that? You really don’t have a couple of years to figure it out since 2017 will determine the baselines for the new payments which are targeted for 2019.
What’s the buzz then from the medical professionals? It is projected that 4 out of 10 physicians in solo or small groups will no longer provide services to Medicare patients. Many practices believe they will be penalized as much as 4% under the MACRA act; few (less than 9%) expect any “bonuses.” Approximately one third of solo or small practices will merge to larger ones to meet the problems and expense.
CMS (Medicare/Medicaid) actually predicted that those with less than 25 physicians would be penalized based on low performance with failure to provide data as the biggest culprit. Solo practices they predicted will have penalties at 87%.
In contrast, CMS estimated that 81% of physicians in a practice with 100 or more clinicians will earn a bonus. Hmm, so, it appears that there may be safety in numbers to help ward off the nightmares created by the economic pressures of CMS, private insurers, electronic health care, and other forces. Good bye then to you valiant solo practitioners!