Physicians Scrambling to Meet MACRA Reporting Requirements and Reimbursement Changes


MACRA's approach to reimbursing physicians is here, but many doctors and administrators are still trying to get a handle on how it works.

MACRA become law in 2015, establishing the Quality Payment Program and dumping the disliked sustainable growth-rate formula for determining physician pay that had long been in place but regularly overridden by Congress.

Under the Quality Payment Program, providers can participate in either the Merit-based Incentive Payment System, known as MIPS, or what is called an Advanced Alternative Payment Model.

Under MIPS, providers essentially stay in fee-for-service Medicare but become eligible for either bonus payments or penalties based on their performance, including evidence of quality improvement, cost reduction or maintaining current levels of spending; efficient use of electronic medical records; and clinical improvement activities such as later office hours and greater use of care coordination

More than halfway through the first year of the rollout of the Medicare Access and CHIP Reauthorization Act (MACRA), fewer than 1 in 4 physicians interviewed for a recent American Medical Association study said they were prepared to meet the statutory requirements this year, which could mean that many will face a financial penalty in 2019, which is when 2017 compliance will be monetarily enforced.

Over half of those surveyed (56 percent) plan to participate in MIPS in 2017, which provides variable incentive payments or penalties based on certain quality and efficiency measures, while 18 percent are expecting to qualify for higher and more stable payments as APM participants.

The survey also found that a majority (51 percent) of physicians who are involved in practice decision-making feel somewhat knowledgeable about MACRA and the QPP, but only 8 percent describe themselves as “deeply knowledgeable” about the program and its requirements. Additionally, 90 percent felt the reporting requirements were “somewhat” or “very” burdensome.

Providers have to start reporting data under MIPS by Oct. 2 if they wish to be eligible for a small bonus.

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