“THE GAME YOU CANNOT WIN”
TMA President Don R. Read, MD, uses this metaphor to de- scribe what the draft MACRA rule would mean for physicians:
“This is how MACRA comes across to me. With original Medicare, we were playing checkers. There were some rules we didn’t agree with, some that were truly stupid, but you pretty much understood the rules. Then with PQRS and meaningful use, we started playing chess. Kind of easy chess, but we were starting to play chess. “And now you say, ‘Well, we’re going to change the game.’
It’s not checkers; it’s not chess; it’s something new. The board’s got two more columns and two more rows. Some of the chess pieces are the same, but we’ve put new ones out there. And we’ve written rules. We started to write them in Mandarin Chinese, but we figured you’d be able to get an in- terpreter and interpret them, so we’ve written them in Mayan hieroglyphs to make sure you don’t understand. “But you have to start playing right away, and don’t worry about the fact that you don’t understand the rules because we have deliberately set the game so that you cannot win. “And by the way, two years from now you’re going to get penalized because you did not win.”
physicians to choose between two ma- jor payment paths: the fee-for-service Merit-Based Incentive Payment Sys- tem (MIPS) and eligible alternative payment models (APMs) beginning in 2019. Data collection to determine each physician’s 2019 Medicare pay- ment rates begins Jan. 1, 2017. MIPS replaces and will include
similar concepts from the current Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM) program, and the EHR incentive program (meaningful use). It adds a new category: clinical prac- tice improvement activities (CPIAs). Physicians’ scores on each of the four measurements will be summed, and the total compared against their col- leagues nationwide. Depending on the comparison, physicians will see Medicare bonuses or penalties of up to 4 percent in 2019 and up to 9 percent in 2022 and beyond. TMA analysts identified a host of
tasks physicians and their office staff must undertake to avoid the penalties or earn the bonuses. They include:
• Learn program requirements (and relearn them after frequent pro- gram revisions),
• Investigate reporting options and requirements,
• Select compliance methods, • Revise standard practice processes and guidelines to incorporate new protocols,
• Train all relevant staff, • Perform related tests or interven- tions,
• Document performance or results, • Report what was documented, • Verify receipt or processing of re- ported data, and
• Defend the data in an audit. The list does not include the cost
and time to install, upgrade, or replace software and to purchase or license new or custom software interfaces, electronic communication methods, or custom reports. (TMA has developed a wide array
44 TEXAS MEDICINE September 2016
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