The final rules for the Medicare physician payment system were released about two weeks ago in a 2,400-page document that was authorized under the Medicare Access and CHIP Reauthorization Act (MACRA) in April of 2015.
Last week, the American Hospital Association hosted a webinar to help their members understand the looming redesign of the program — and what it means for physician payouts.
"The passage of MACRA was much anticipated in that it did away with draconian physician fee schedule cuts (the current system that had to be overridden by Congress every year)," Akin Demehin, MPH, director of policy at AHA explained. "The new payment system will emphasize value-based care."
Under MACRA, doctors will increasingly be compensated in a system featuring both incentives and penalties for best practice protocols to drive quality and control costs. This will be accomplished either through a Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APM).
The final rules will give doctors some flexibility in allowing them to ramp up slowly in 2017, with full operations commencing in 2019.
MACRA is another piece of a health care delivery redesign linked to the Affordable Care Act to move from volume-based, fee-for-service medicine to an at-risk model stressing population wellness management. The intent is to promote prevention and improve clinical outcomes to control costs.
Still, as the final rule's 2,400-page length suggests, MACRA is extremely complicated.
"There is a lot to know and a lot to learn about the new payments," Demehin said. "The final rules reflected the concerns the AHA and other stakeholders had expressed during the draft review."
Here are four of the key points he stressed in his presentation:
1. As part of the slow ramp-up toward data-based reporting, in 2017, clinicians will only be required to report a minimum of 90-days’ worth of data documenting factors relevant to the quality and cost of their services.
2. While that reporting may be limited in 2017 to one quality and cost factor (while avoiding penalties), providers who take the initiative to report more data from the beginning are more likely to receive positive payment adjustments going forward.
3. Most physician practices already in APS programs will not qualify for bonuses in the first year. There are also exclusions for some clinicians who do need to meet a minimum threshold for generating Medicare charges, particularly in rural areas.
4. MACRA payments are scheduled to become increasingly intense through 2026. This is to facilitate the move away from fee-for-service, volume-based medicine to population health management that promotes prevention and wellness, as well as bundled payments for complex medical procedures.
At the end of the presentation, 625 attendees had the opportunity to share their concerns about challenges relating to the conversion. Many of the comments voiced traditional barriers to past changes in the health care delivery model, including:
- Physician buy-in and resistance
- Lack of adequate administrative support
- Data automation needs
- Ongoing education to aid implementation
- Impact on Accountable Care Organizations
More initiatives like the one undertaken by the AHA will be necessary in order to educate providers regarding the impact that changing reimbursement will have on their practice. According to a survey released in September by the Healthcare Finance Management Association, only about a fifth of all physicians are "familiar" with MACRA changes.