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.
A: MACRA stands for “Medicare Access and CHIP Reauthorization Act.” It is the next step in the transformation of health care reimbursement under Medicare. The first MACRA final rule and regulations were published in the November 4, 2016 Federal Register. For more information on the final rule, watch the APA webinar entitled MACRA Final Policy Overview.
A: Many psychiatrists will be exempt from participation in MACRA if they fall below a “low-volume threshold”; it is estimated that for 2017 reporting about one-half of all psychiatrists will be exempt. CMS has defined the threshold if the psychiatrist or group practice had:
For the 2017 reporting year, the low-volume threshold periods are either September 2015 through August 2016 or September 2016 through August 2017. To figure out whether or not you are exempt, please refer to the CMS website.
A: We strongly recommend that you go to the APA website and review the MACRA 101 primer.
A: This is best summarized in a graphic from CMS.
A: YES – there will be monetary consequences to you and your practice if you do a good job of participating in MACRA. If you are exempt from MACRA but are in-network with private insurance, it might also help you to participate in MACRA. We anticipate that private insurance will soon follow suit with the MACRA guidelines for outcome reporting. To better understand why quality reporting should be important to you as a psychiatrist, watch the APA webinar entitled Quality Reporting 101: A How-To Guide for Psychiatrists.
A: Since MACRA is so new, there are no standards for measurements yet. However, you can get some great ideas from the APA webinar entitled MIPS Quality Category. Also refer to the CMS website tool for Quality Measures and Improvement Activities.
A: Again, since MACRA is so new we don’t have data yet. If you are interested in learning with your peers, we have two suggestions:
A: This will be highly variable depending on the sophistication of your practice, your electronic medical record, and your administrative staff support.
A: Get involved now! Although it can seem confusing and overwhelming, there are many choices within the MACRA program to make it fit your needs and your patients. The NCPA and the APA are here to help so if you have specific questions please contact us.
What You Need to Know about the Final MACRA Rule
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.