MACRA 911: What Questions Should You Be Asking Right Now?

While there is still no official start date confirmed for MACRA, and a final rule expected to be published Nov. 1, physicians continue to be on edge about the timing of this new program, which is set to replace the sustainable growth rate formula for payment adjustments under Medicare. With November just around the corner, what questions should you be asking right now?

Unfortunately, nearly half of U.S. physicians are unfamiliar with the Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, according to a new survey of 600 doctors by research and consulting giant Deloitte. Under MACRA, CMS would begin measuring performance in 2017 for payments that begin in 2019 – a timeline that has been a huge concern for physicians that are still awaiting a final rule.

The Medical Association joined the American Medical Association and numerous physician groups to urge CMS delay implementation of MACRA, and ensure new federal reimbursement programs “reward physicians for the improvements they make to their practice and the quality of care they provide to their patients.”

According to HealthcareFinanceNews online, there are some questions physicians should be asking about MACRA right now:

Who are your eligible clinicians and how are they structured?

MACRA isn’t just about physicians. The answer to this question is important to allow you to formulate a solid plan of action to determine whether you will use MIPS (be measured and paid based on quality, resource use, clinical practice improvement and Meaningful Use), or APM (a payment method with a time limit of six years).

How do you optimize MIPS reporting and performance?

Most physicians will start under the MIPS system until you decide what reporting system suits your practice best: what measures you would perform best on, whether you feel confident in your ability to perform well under these measures, and ultimately if you want to stay under just MIPS.

Should I participate in an APM, and do I want to do a MIPS APM or Advanced APM?

Look at what models are available in your area, as some are geographically based, and also what is available for application. There are application periods that need to be taken into account. One thing to remember if you go with a MIPS APM, a one-sided model that carries no direct risk, you still have to be building your capacity to take on risk even while maximizing your time as a MIPS APM.

How are you communicating your strategy to your organization, the clinicians you work with and to your community partners?

Everyone needs to be on the same page. The official, finalized rules will be published for implementation in November, at which point providers will be expected to quickly prepare for reporting in 2017. Those reports will determine reimbursement, and penalties and bonuses where applicable, in 2019.