Merit-based Incentive Payment System under MACRA set to increase both penalties, reimbursements

MIAMI — The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, will begin the new Merit-based Incentive Payment System this year, according to a speaker here.

MACRA recently replaced the Sustainable Growth Rate (SGR) program, avoiding a 21% cut. Its new payment system, the Quality Payment Program, has two tracks: The Advanced Alternative Payment Model or the Merit-based Incentive Payment System (MIPS).

Michael D. Kaufmann

“MACRA is the introduction, another try at the bite of the apple, for CMS and for the government to change from quantity of health care services to quality of health care services,” Mark D. Kaufmann, MD, of Icahn School of Medicine at Mount Sinai, New York, said in a presentation. “They want to pay based on results; not on how much you do, but what you’ve actually done.”

According to Kaufmann, due to the current rules for the Advanced Alternative Payment Model, most dermatologists and clinical aesthetic physicians do not use this track and instead follow MIPS. Under MIPS, physicians will receive either reimbursements or penalties based on their performance on several metrics. The reimbursements and penalties will begin at 4% in 2019 and rise to 9% by 2022.

MIPS is made up of four “buckets,” Kaufmann explained. “Quality measures” will replace the old Payment Quality Reporting System; “costs” will replace the “value-based modifier” in 2018; “advancing care information” will replace “meaningful use program”; and a new category known as “improvement activities” will be implemented.

First performance year for MIPS began Jan. 1, 2017, but physicians can begin trying to fulfill minimum requirements by Oct. 2, 2017 to avoid any penalty. Performance will be judged in 2019 and will continue on a 2-year model.

Kaufmann advocated that all physicians consider the lax “pick-your-pace” minimum requirements set for MIPS this year to avoid any penalty and qualify for anywhere between a 0% and 4% bonus. – by Talitha Bennett

Reference: Kaufmann M. MACRA Overview: The Future of Reimbursement. Presented at: South Beach Symposium 2017; Feb. 9-12, 2017; Miami Beach, Florida.

Disclosure: Healio.com was unable to determine whether Dr. Kaufmann has a direct financial interest in the products discussed in this article or if he is a paid consultant for any companies mentioned.