UPDATE: On September 8, 2016, CMS announced its intention to include several options for the 2017 MACRA implementation timeline. Physicians participating in one of the options will avoid a penalty in 2019. While we are encouraged by CMS' efforts at flexibility, ASCRS is concerned about the lack of details included in the CMS announcement, and will continue to advocate for further changes to be included in the final rule. The final rule is expected no later than November 1, 2016. Click here for the Announced Options for the MACRA Implementation Timeline.
MACRA Implementation: Quality Payment Program
ASCRS•ASOA played a leading role in the medical community's efforts to permanently eliminate the flawed Sustainable Growth Rate (SGR) formula. The new law, Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), establishes new ways to pay physicians who are caring for Medicare beneficiaries.
Under MACRA, SGR was replaced with a value-based reimbursement system called the Quality Payment Program (QPP), which includes the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).
Most opthalmologists will participate in the MIPS program. The MIPS program will be based on four performance categories: quality, resource use, advcancing care information, and clinical practice improvement activities. Three existing Medicare reporting programs are being used to make up the categories: the Physician Quality Reporting System (PQRS) has become the quality category, the Value-based Payment Modifier (VM) program has become the resource use category, and the Medicare Electronic Health Record (EHR) Incentive (meaningful use) program is becoming the advancing care information category. Clinical practice improvement activities will be a new category. ASCRS has developed individual guidelines for each of the categories found below:
MACRA is the most significant change in Medicare reimbursement in decades. The timeline for implementation is aggressive. While the final rule is not expected to be released until sometime in the fall of 2016, we are recommending that members begin preparation now, as CMS has proposed to use performance data from 2017 and lack of compliance with reporting could result in penalties.
- Use this checklist to help you prepare.
- We have also compiled a list of FAQs to assist members understand MACRA.
In addition, a special edition of ASOA on Tour is being held Nov 4–5 in Tampa, Florida to provide a day-long, comprehensive look at MACRA. The event is designed to so that attendees will leave with the necessary knowledge and tools to prepare practices for MACRA implementation.
Event registration can be found here.
We will continue to update this web page with information as it becomes available. Additional information on the proposed rule and the MACRA statute is available below.
As always, ASCRS•ASOA Government Relations staff is available to assist you or answer questions at 703-591-2220.