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MACRA to Hit Small Practices Hard: Page 3 of 3

MACRA to Hit Small Practices Hard: Page 3 of 3

7. Quality measures go down

Unlike in PQRS where it was nine quality measures, the MIPS "Quality" part will ask physicians to choose six quality measures to report on from a list of options tailored to specialty and practices. According to CMS, for individual clinicians and small groups (2-9 clinicians), MIPS will calculate two population measures based on claims data, meaning there are no additional reporting requirements for clinicians for population measures.

8. Cost doesn't require reporting

CMS will calculate the cost measures based on claims and availability of sufficient volume. As such, clinicians will not have to do any extra work for this component.

9. APMs offer an alternative, even if it's for a small number of physicians

APMs are payment models such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs). In 2019 through 2024, physicians participating in APMs would receive a lump sum payment of 5 percent of their prior year Medicare Part B payment.

Most physicians won't be able to participate in this track. There are requirements on how many payments through an APM you receive to be eligible and for the first few years, it can only be Medicare patients and payers. In subsequent years, CMS says it will allow physicians in these models to include non-Medicare payers and patients and the number will increase.

10. Because of the election, this is fluid

As Robert Tenannt, health IT policy director of the Medical Group Management Association, said in an interview with Physicians Practice, 2016 is an election year and often, rules are put on hold in the final months of an outgoing administration. He says new administrations are given a chance to re-release, modify or not release the last administration's rules. In other words, this could all be for naught.


*Physicians Practice sought clarification from CMS to confirm that this is what this chart is indicating.

Chris Mazzolini from our partner publication, Medical Economics, contributed to this reporting



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