Inside MACRA: The Quality Payment Program for Physicians

The previous blog, What is the MACRA Quality Payment Program? presented an overview of the new Medicare reimbursement program for physicians under the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015, and outlined the two participation pathways, the MIPS and the APM.

This blog will delve a little deeper into the program itself and summarize how it applies to physician and nonphysician Medicare service providers.

Here Are The Basics as indicated by a recent CMS presentation.

WHEN IS IT EFFECTIVE?

The QPP becomes effective as of January 1, 2017. Data provided by eligible providers (EPs) for services provided during the year 2017, beginning as of January 1, will be used to determine the rate of reimbursement two years later, in 2019.

WHAT IS THE TIMELINE for PARTICIPATION?

January 1, 2017 to December 31, 2017 is the timeframe for recording at least some level of participation - one quality measure or one improvement activity - in order to avoid a 4% negative reimbursement adjustment in 2019.

January 1, 2017 to October 2, 2017 is the timeframe for beginning a 90 day period of participation to qualify for at least a minimal positive payment adjustment in 2019.

January 1, 2017 is the date you must start recording data to provide a full year of participation and qualify for up to a 5% positive payment adjustment.

WHEN DOES THE DATA NEED TO BE SUBMITTED?

Regardless of the level of participation all the data needs to be submitted by March 31, 2018.

WHO QUALIFIES TO PARTICIPATE?

Everyone qualifies for the Quality Payment Program who is a

• Physician,
• Physician assistant,
• Nurse practitioner,
• Clinical nurse specialist, or
• Certified registered nurse anesthetist;

And who

• Bills Medicare more than $30,000 a year, plus
• Provides care for more than 100 Medicare patients a year, and
• Is not in the first year of treating Medicare patients.

WHAT IF I DON’T PARTICIPATE?

Providers who choose not to participate are subject to a -4% payment adjustment in 2019, increasing to -5% in 2020, -7% in 2021, and -9% in 2022 and beyond.

WHAT IF I DON’T KNOW HOW TO DO THIS?

Not to worry. The federal government has budgeted 20 million dollars a year for the next five years to train physicians in how to meet the QPP requirements. You can find more information about this $100,000,000.00 MACRA Quality Improvement Direct Technical Assistance (MQIDTA) program in this previous blog.

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