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MACRA to Hit Small Practices Hard

MACRA to Hit Small Practices Hard

This week, CMS published the proposed rule for implementation of the Medicare Access and Summary CHIP Reauthorization Act of 2015 (MACRA). MACRA will change the way physicians are reimbursed for Medicare, combining and configuring the Physician Quality Reporting System (PQRS), the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program (Meaningful Use).

MACRA will include two paths for physicians to get compensated on under Medicare: the Merit-based Incentive Payment System (MIPS), which affects up to 746,000 eligible physicians by next year, for adjustments in 2019, and Advanced Alternative Payment Models (APMs), which affects a far fewer number of eligible physicians at up to 90,000.

For most physicians, MIPS will be a reality next year. CMS will be measuring their performance in 2017 and adjusting those payments in 2019. The program will judge physicians based on four categories: Cost, replacing the cost component of the Value Modifier Program (10 percent of their total score in year one); quality, replacing PQRS and the quality component of the Value Modifier Program (50 percent of their total score); clinical practice improvement (15 percent of their total score); and advancing care information, replacing Meaningful Use (25 percent of their total score). Based on that total score, physicians will have a payment adjustment (either negative or positive) of up to 4 percent in 2019. 

While the proposed rule is incredibly complex — 962 pages — here are some early takeaways that physicians must acknowledge off the bat. Physicians Practice will continue analysis and coverage of this rule.

1. For smaller practices this is going to hurt their wallet

CMS itself projects, using 2014 data, 87 percent of solo practices will face a negative adjustment in year one of MACRA, equating to a total of $300 million lost. The numbers aren't much better for practices with 2-9 eligible docs. From page 676 in the rule:*



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