The Medicare Access and CHIP Reauthorization Act, known as MACRA, is one of the most significant payment changes since Medicare’s inception in 1965.
"Physicians and other clinicians payments will be at risk, beginning with a plus or minus swing of 4% in 2019, that increases to plus or minus 9% by 2023," says Chester A. Speed, JD, LLM, vice president, public policy, AMGA.
To be successful under MACRA, providers will have to consider the clinical, financial and cultural changes they need to make to do well under risk, according to Speed.
"And while providers can rightfully say they’ve seen this before in the 1990s, risk, or value-based payments are now written into law and they are here to stay," he says.
What impact will MACRA have on your organization? We asked experts to tell us.
1. MACRA will require physician groups to understand and implement an incredibly complex payment system. According to CMS, the intent of MACRA is to merge existing value-based payment methodologies into a new, “two-track system for physician payments based more on value and less on volume.”
"However, due to the many variables involved, meeting MACRA requirements is going to be difficult for many physicians," says Bing Pao, MD, director of provider relations for CEP America. He currently serves on the California Medical Association MACRA Task Force and the American College of Emergency Physicians (ACEP) APM Task Force and was the past chair of the Reimbursement Committee for the California Chapter of ACEP.
For example, Pao says, with the new Merit-Based Incentive Payment System (MIPS) there is a composite score based on specific reporting parameters and performance. In addition there are multiple categories and performance valuation weights, with changes over time.
"Initially, it will be confusing, to say the least," Pao says. “All this requires providers to: 1) fully understand the incredibly complex new rules; 2) successfully employ all measures outlined; and 3) perform, track and report based on MACRA measures."