Board of Directors Report to the Membership from the November 7, 2015 Meeting
The Wisconsin Academy of Family Physicians (WAFP) Board of Directors meets four times a year. Most recently, the Board met on Saturday, November 7th. In its ongoing effort to continue providing value to you, the WAFP Board is again sending out a short communique to the membership outlining a decision or discussion the Board has undertaken and how these discussions impact you as a member. We hope you find this information useful.
The Board met in the morning for strategic planning and held the Board meeting in the afternoon. As part of the afternoon session, the Board engaged in a mega issue discussion concerning MACRA and the significant impact this will have on all members. The Board agreed that WAFP must help its members understand and be prepared for this significant change.
MACRA - Why these 5 letters are so important to you and your future
In April 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2, also known as MACRA). This law:
- Repeals the Sustainable Growth Rate methodology for determining updates to the Medicare physician fee schedule.
- Establishes annual positive or flat fee updates for 10 years and institutes a two-tracked fee update afterwards.
- Establishes a Merit-Based Incentive Payment System (MIPS) that consolidates existing Medicare fee-for-service physician incentive programs.
- Establishes a pathway for physicians to participate in alternative payment models (APM), including the patient-centered medical home.
- Makes other changes to existing Medicare physician payment statutes.
The following is a timeline for MACRA implementation:
- July 2015 through December 2015: Medicare physician payments increase by 0.5 percent.
- 2016 through 2019: Medicare physician payments increase by 0.5 percent each year.
- January 2019: Based on eligibility, physicians enter either the APM track or the MIPS track.
- 2020 through 2025: Medicare physician fee-for-service payments remain at 2019 levels with no updates.
MACRA defines any of the following as an alternative payment model (APM):
- An innovative payment model expanded under the Center for Medicare & Medicaid Innovation (CMMI), including Comprehensive Primary Care (CPC) initiative participants but not Health Care Innovation Award recipients.
- A Medicare Shared Savings Program Accountable Care Organization (ACO).
- Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program, or another demonstration program required by federal law.
If you or your practice group continues to participate in Medicare, MACRA requires that you choose one of the two following payment models.
Alternative Payment Models (APM)
An APM must require participants to meet all of the following criteria:
- Uses quality measures comparable to measures under the MIPS
- Uses certified electronic health record (EHR) technology
- Bears more than nominal financial risk OR is a medical home expanded under the CMMI
- Has increasing percentage of payments linked to value through Medicare or all-payer APMs
If you are eligible and choose to participate in a qualifying APF, you will receive a 5 percent lump-sum bonus on your Medicare payments for 2019 through 2024. Beginning in 2026, you will qualify for a 0.75 percent increase in your payments each year.
Merit-Based Incentive Payment System (MIPS)
The Merit-Based Incentive Payment System is a new program in the Medicare fee-for-service payment system. It consolidates three existing programs - meaningful use (MU), the Physician Quality Reporting System (PQRS), and the Value-Based Payment Modifier (VBPM) - into a single program.
The MIPS will assess individual physician performance in four categories to generate a composite score on a 0-100 point scale. The categories are:
- Resource use
- Meaningful use of certified EHR technology
- Clinical practice improvement activities
Beginning in 2019, physicians participating in the MIPS will be eligible for positive or negative Medicare Payment adjustments that start at 4 percent and gradually increase to 9 percent for 2022. The threshold for these payment adjustments will the the mean composite score for all MIPS-eligible professionals during the previous performance period. Distribution of payment adjustments will follow a bell-shaped curve:
- Physicians who score at the threshold (i.e. earn the mean composite score) will receive no payment adjustment.
- Physicians whose composite score is above the mean will receive a positive payment adjustment on each claim for the following year.
- Physicians whose composite score is below the mean will receive a negative payment adjustment on each cliam for the following year.
Physicians with high composite scores will be eligible for a positive payment adjustment that is up to three times the baseline positive payment adjustment for a given year. For example, the baseline positive payment adjustment for 2019 will be 4 percent, so high performers will be eligible for a positive payment adjustment of up to 12 percent. For 2019 through 2024, an additional positive payment adjustment of up to 10 percent will be available to exceptional performers.
Beginning in 2026, all physicians participating in the MIPS will be eligible for a 0.25 percent increase in their payments each year.
What can you do now to prepare for MACRA implementation?
If you haven't reported data on quality measures through the PQRS or as part of meaningful use, start as soon as possible. Penalties for not reporting or for low quality may impact you this year. More information on Medicare penalties is available here.
If you submitted quality data during the last calendar year, you should have access to your Quality and Resource Use Report (QRUR). This report will help you understand your performance in terms of cost and quality so you can prioritize potential areas for improvement.
If your practice doesn't provide chronic care management (CCM) services, consider starting now. Medicare began paying for CCM codes on January 1, 2015. By offering CCM services, your practice will be a step closer to implementing the five comprehensive primary care functions promoted by the CPC initiative. You may also qualify to participate in the APM track. Information on chronic care management and resources to help you start providing CCM services in your practice are available here.
How can I learn more?
Over the coming year, WAFP will keep members updated on MACRA through targeted e-newsletters, webinar presentations, regional discussions, and legislative alerts.
Check out the WAFP website for timely updates and useful resources.