
5 Things to Know About the New MACRA Rule
This sweeping proposal is the biggest step yet in shifting reimbursement from a volume-based to a value-based system. Stakeholders offered mixed opinions this week.
On Wednesday, CMS released a 962-page
1. Several existing programs would be streamlined. A host of separate programs affecting doctors—the Physician Quality Reporting System, the Value-Based Payment Modifier, and the Medicare EHR Incentive Program—will be combined into a single scoring metric called MIPS, for Merit-Based Incentive Payment System. Reimbursement will be based on 4 areas: quality, cost, technology use, and practice improvement. CMS expects most doctors to use this system, but others may be eligible for the more flexible Alternative Payment Models (APMs).
2. “Meaningful Use,” which many loathe, will go away. A new system, Advancing Care Information, would replace the current EHR reporting requirements starting January 1, 2017. This was a priority of the
3. Limits on “Alternative Payment Models” have drawn fire. Unlike the AMA, the
4. Some fear that once again, small players will be pushed aside. Critics say the regulations favor hospitals and large systems at the expense of independent practices, and that will mean more consolidation. Even Farzad Mostashari, MD, ScM, who called the proposal the most “substantive change to how healthcare is paid for in a couple of decades,” said it had a “blind spot” in its assumptions about primary care providers and accountable care organizations, which would need to be fixed.
5. Remember the saying, “It ain’t over till it’s over.” With so much on the line, stakeholders who aren’t happy with the proposal will press furiously for changes, both ahead of the June 26, 2016, comment deadline and into the fall, when the MACRA rule will be adopted. Both AMA’s Stack and CMS referred to the proposal as a “first step” on what promises to be a very interesting road.
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