As the Centers for Medicare and Medicaid Services' implement the Medicare Access and CHIP Reauthorization Act of 2015, providers will have to begin reporting quality measures through a merit-based incentive system, through alternate payment models or by surrendering a percentage of their Medicare earnings, HealthData Management reports. Here's what you should know.
1. MACRA is scheduled to begin payments in 2019. It's rooted significantly in quality-driven incentives to increase value and begin the mass transition to value-based care to other programs.
2. Reimbursement will now reward quality above all else. Followed by advancing care information, clinical practice improvement and cost.
3. MACRA eliminates the sustainable growth rate formula, and the cuts that had been in effect for the last two decades. SGR was created in 1997 to control costs. Although it was considered to be better than the rule it replaced, it was unpopular.
4. To prepare for MACRA, physicians need to have an "all in" mentality that is present through every level of an organization using data.
5. Physicians will have to decide whether they will participate, and between three options affecting their fee-for-service reimbursement.
Those options are:
- To participate in a qualifying alternative payment model and potentially receive a 5 percent performance based increase.
- To participate in the Merit-based incentive payment system and receive a payment based on quality performance, resource use, electronic health records and clinical practice improvement activities.
- Or to not participate and have your reimbursement cut by 4 percent with the expectation the percentage will increase in the coming years.
6. For larger practices, try establishing overarching practice quality goals, and help departments create tactics to align with those goals; adopt a commitment to quality that starts at the top and resonates through to the bottom; leverage data to drive the understanding and importance of performance and assess the performance gap.
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