REGULATORY REVIEW
MACRA Is Just Around the Corner New Medicare physician payment system begins January 1, 2017 BY SHEILA MADHANI
The Medicare Access and CHIP Reautho- rization Act of 2015 (MACRA) was hailed at the time of its enactment
for repealing the Sustainable Growth Rate (SGR), the much maligned annual payment adjustment factor that perennially forced Congress to approve legislation to avoid steep, often double-digit cuts to Medicare physician payments. This new law profoundly alters how and how much physicians will be paid for services furnished to Medicare beneficia- ries and how physicians will interact with the program. These changes are expected to alter payment and impose substantial new administrative obliga- tions on physician groups and, poten- tially, realign the market for physician services. For ASCs, these changes present some new and unique chal- lenges and opportunities. The MACRA legislation is another
example of Congress’s commitment to transitioning Medicare from a fee- for-service system to one that incen- tivizes value—i.e., improves qual- ity and reduces cost—over volume. Beginning January 2017, physicians will be evaluated under a new perfor- mance measurement program called the Merit-Based Incentive Payment System (MIPS). This system will link physician payment to performance. It also consolidates several existing physician performance measurement programs into a single program. While MACRA-related payment adjustments are not scheduled to begin until 2019, physicians must understand the program now because payment adjustments in 2019 will be based on reporting and performance in 2017.
Merit-Based Incentive Payment System Under MIPS, eligible professionals— physicians and certain other speci- fied non-physician practitioners— will be measured in four performance areas: Quality, which is comparable to today’s Physician Quality Report- ing System program, Advancing Care Information, which is the next gener- ation of the Meaningful Use program, Clinical Practice Improvement Activi- ties and Resource Use. These four cat- egories will encourage investments in technology, reward a service orienta- tion and incentivize quality improve- ment and efficiency. Physicians and other eligible pro- fessionals will be required to report data in three of these categories— the Centers for Medicare & Medic- aid Services (CMS) will use claims- based data to measure Resource Use—and CMS will calculate a com- posite score based on a provider’s performance in all four areas. Providers
that perform above a
median will receive a positive adjust- ment to their annual payment update up to 4 percent, while those that perform
Track the Latest Regulatory and Legislative News for ASCs
Visit ASCA’s web site every week to stay up to date on the latest government affairs news affecting the ASC industry. Every week, ASCA’s Government Affairs Update newsletter is posted online for ASCA members to read. The weekly newsletter tracks and analyzes the latest legislative and regulatory developments concerning ASCs.
www.ascassociation.org/ GovtAffairsUpdate
below the median will receive a negative adjustment up to 4 percent. This adjust- ment will gradually increase to ±9 per- cent by 2022. Physicians in the top 25 percent of MIPS scorers will be eligible to receive an additional bonus payment, which could be substantial. In this way, physicians will be measured and com- pensated based on performance relative to their peers.
The MIPS program raises a num- ber of issues for ASCs and physicians who operate in them. For example, most ASCs do not and will not have the nec- essary certified Electronic Health Record (EHR) systems in place, so physicians who provide a majority of their services in the ASC setting could find it difficult to meet the criteria for successful partici- pation in the Advancing Care Information (ACI) category. In comments to CMS on the MACRA Proposed Rule, ASCA urged CMS to exempt ASC-based physi- cians from the ACI performance category when calculating the total MIPS score, but whether the agency obliges is yet to be seen; final regulations were not avail- able at the time this article was written. In the meantime, ASCA is seeking to
advance H.R. 5273, the Helping Hospi- tals Improve Patient Care Act—legisla- tion currently pending in Congress that would exclude ASC patient encounters from calculations that determine penal- ties for physicians under the Electronic Health Record Incentives Program and MACRA, until such time as there is a certified EHR product available for the ASC setting. ASCA also recommended that for clinicians who do not have ACI scores, CMS re-weight the composite score to prevent these MIPS-eligible clinicians from being penalized under the MIPS scoring methodology for fur- nishing services in ASCs.
ASC FOCUS NOVEMBER/DECEMBER 2016 21
Page 1 |
Page 2 |
Page 3 |
Page 4 |
Page 5 |
Page 6 |
Page 7 |
Page 8 |
Page 9 |
Page 10 |
Page 11 |
Page 12 |
Page 13 |
Page 14 |
Page 15 |
Page 16 |
Page 17 |
Page 18 |
Page 19 |
Page 20 |
Page 21 |
Page 22 |
Page 23 |
Page 24 |
Page 25 |
Page 26 |
Page 27 |
Page 28 |
Page 29 |
Page 30 |
Page 31 |
Page 32 |
Page 33 |
Page 34
