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MACRA Resources

Payment Reform is Coming

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) changes the way psychiatrists and other physicians working with Medicare patients will be paid. The goal is to reimburse care based on quality and value rather than the number of services you provide. Before the final rule was announced, the APA raised several concerns about MACRAs impact on psychiatry and their advocacy efforts paid off. To break down the new rule, the APA is working on a web-based toolkit and webinar series to help members understand the new MACRA rule. Learn more at psychiatry.org/MACRA.

MACRA Frequently Asked Questions

Here are some Frequently Asked Questions that NCPA has been receiving regarding MACRA and payment reform. The APA has great information on its website, so we have tried to answer these questions briefly and then provide the website link that will give you more information.

Q: What is MACRA?

Q: Do I have to participate in MACRA?

Q: How do I get started in MACRA?

Q: Do I have to have an EHR?

Q: What is the timeline? What do I need to do first? By when? What next?

Q: Are there good reasons for me to participate in MACRA?

Q: What measures are other psychiatrists using?

Q: How are other psychiatrists incorporating this into their practices?

Q: How much time will it take?

Q: How do I make this of value to my patients?

What You Need to Know about the Final MACRA Rule

  • Nearly 50% of psychiatrists will be exempt in 2017. You will be exempt if one of the following applies:
    • You see less than 100 patients OR no more than $30,000 in annual Medicare billings. This is considered a "low volume threshold." Nearly 49% of psychiatrists who see Medicare patients will fall under this category.
    • You just enrolled in Medicare this year
    • You qualify for the incentive for "advanced" alternative payment models
  • "Pick Your Pace" Flexible reporting period in 2017
    • Psychiatrists who choose to participate in MIPS can ease into reporting in 2017
  • Decreased requirements to meet "full reporting" to earn a bonus in 2017
    • Psychiatrists will have to report four medium-weight OR two high-weight Clinical Practice Improvement Activities and five Advancing Care Information measures (for EHR use) to get credit.
  • Psychiatrists who do MIPS reporting will not be penalized for seeing sicker patients for the first year
  • Earn a bonus for some participation in alternative payment models (APMs) such as an Accountable Care Organization (ACO)
    • If you have more than 35% of Medicare covered services or 20% of your Medicare patients in "advanced" APMs, you will be exempt from MIPS reporting in 2017 and can earn a 5% bonus in 2019

Merit-Based Incentive Payment System (MIPS)

MIPS combines portions of three quality programs: Meaningful Use (MU), the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier (VBM). MIPS also adds a new category of Clinical Practice Improvement Activities. 

Providers receive payment adjustments based on measures of quality, resource use, advancing care information (EHR use) and clinical practice improvement. 

Learn More About MIPS


Alternative Payment Models (APMs)

APMs include Accountable Care Organizations, Bundled Payments and Medical Homes. Participating in an advanced APM can exempt you from MIPS, and can lead to more favorable financial incentives, including a potential 5% lump sum bonus payment. Choosing an APM requires you to meet quality, financial risk and payer/revenue mix measurements.

Learn More about APMs