MACRA: Be Prepared for Change

Changes in healthcare standards are something we have come to expect, and this year is no different. Late last year CMS released the final ruling for the Medicare Access and CHIP Reauthorization Act (MACRA) which will affect participating physicians’ payment in 2021. The law strives to transition physician reimbursement from fee-for-service to pay-for-performance incentives requiring eligible professionals to participate in one of two payment tracks: Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

Why Imaging Leaders Should be Focused on MACRA

Adherence to MACRA’S performance categories directly impacts radiologist reimbursement. Additionally, MACRA aims to move away from a fee-for-service model to quality-based payment. By urging providers to seek out risk-based payment models, MACRA will curve imaging utilization and push imaging leaders to focus on population health strategy.

Here’s What You Should Know

It’s important to not just familiarize yourself with MACRA but also stay on top of policy changes. Waiting for the final rules keeps practices constantly behind the curve on compliance and reporting measures leading to possible penalties for failing to meet guidelines and regulations. Here are seven changes to MACRA this year that should be top of mind to ensure your practice is prepared.

1. Greater expectations

A third low volume threshold has been added. Clinicians and groups must meet one of the three criteria to be exempt from the Quality Payment Program (QPP).

• Provide $90,000 or less in Medicare Part B charges for covered services
• Care for 200 or fewer Medicare beneficiaries
• Provide 200 or fewer services covered under the Physician Fee Schedule (new in 2019)

2. MIPS category percentage shift

The quality performance category shifts from 50% of the physician’s score to 45%, while cost increases from 10% to 15%.

3. Higher payment adjustments for 2021

Payment adjustments will range from -7% to 7% in the 2021 payment year.

4.  Physicians must have certified electronic health record (EHR) software for the 2019 reporting year.

5. Bonus for small practices

Small practices, defined as having 15 or fewer eligible clinicians, will continue to receive a bonus to their scores in 2019 but it will be included in the quality performance category instead of a standalone bonus. The bonus will increase to 6 points if the clinician submits data on a least one quality measure.

6. Physicians can opt-in to MIPS

Any clinician or group that met one or two, but not all, of the low-volume exemptions, could choose to opt-in to MIPS. However, the decision is irrevocable.

7. More clinician types are MIPS-eligible

For 2019, the definition for MIPS-eligible clinicians expanded to include:

• Physical Therapists
• Occupational Therapists
• Qualified Speech-Language Pathologists
• Qualified Audiologists
• Clinical Psychologists
• Registered Dietitian or nutrition professionals

This will not be the last we hear about MACRA. Practices should be thinking about long-term goals, getting comfortable with MACRA and MIPS requirements and working on improving and maximizing their scores in the various categories. They should closely examine their practices to start making significant changes in how they deliver care to provide better outcomes and more cost-effective care.