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What is MACRA, and do you Qualify?


What is MACRA, and do you Qualify?

Healthcare in 2017 looks very different from what it was even two decades ago. Modern technology and innovative tools have made their way into doctors’ offices.  Seeing a computer at the dentist might have been unusual once upon a time.  Today most of us expect to see computers, smartphones and tablets when we go visit the dentist.

Technology is not the only new addition to healthcare. In recent years the government has been implementing a series of programs aimed at improving health outcomes for the general population. The meaningful use program targeted the use of technology in healthcare, with providers receiving incentives for implementing EHR software.  Other programs have focused on improving the quality of care, changing payment models and other areas of the industry.

What is MACRA?

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. This program is aimed at changing the way Medicare payments are handled. Under this program, the sustainable growth rate model that has been used for decades is now gone.

In its place, providers can choose from two alternative tracks – the Merit-based Incentive Payment System (MIPS) or the Advanced Alternative Payment Models (APMs). Providers can select which option to take based on their practice size, patient population, location and a few other factors.

The first reporting period under this program began on the 1st of January 2017. Many providers received their letters of participation in the new program while others have been exempted from reporting for this year. CMS has even allowed some providers to avoid penalties by reporting partial data.  On the flip side however those providers will also forgo any bonuses that they might be eligible for.

Merit-based Incentive Payment System (MIPS)

Most dental offices will fall under the merit-based incentive payment system or MIPS. Doctors will be scored across 4 different performance categories. These are quality, resource use, clinical practice improvement and advancing care information using health information technology. This final criterion will be based on the meaningful use program that provides incentives for EHR use to providers.

Following complaints from industry groups and physicians regarding the onerous responsibilities of following several different government programs, CMS has relaxed several rules and provided more exemptions from participation. A new draft rule under consideration will exempt providers with 90,000 dollars in Medicare revenue or fewer than 200 unique Medicare patients per year from complying. This is clearly aimed at helping smaller practices and those providers in underserved or rural areas.

The MIPS program has two different financial impacts for providers. The first one is a small inflationary adjustment that is made every year. The second one comes with both benefits and penalties based on a 100-point score. Penalties for low scores start from 4% in the first year and go up to a maximum of 9% by the end of the fourth year. On the other hand, incentives also increase to the point where the value-based adjustments can go up to 337% of Medicare payments.

By this time most providers will already know if they are eligible to participate or to claim an exemption from the program. However even if you are exempt from participation for the first reporting period, it is a good idea to start getting ready for the future. Reducing resource use and improving quality are admirable goals for any clinic. Even if you don’t report any data, it is an appropriate time to start thinking about the future.  Eventually all providers will have to comply with MACRA in order to receive Medicare payments. So why not get started now?