The U.S. health care system is on the precipice of groundbreaking, knock-your-socks off change that opens the door to a whole new era of Medicare physician payment.
Think back. Nearly a year ago, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) and finally eliminated the ill-conceived Medicare sustainable growth rate (SGR) formula. The vacuum created by the demise of the SGR is rapidly filling with new payment opportunities presented by MACRA.
One thing is certain: MACRA marks the beginning of the end for fee-for-service payment, and the AAFP knows this presents an enormous opportunity to drive broad payment reform for primary care. That's why the Academy is grabbing every opportunity to help shape the rules and regulations that will implement this law.
There's a lot for family physicians to digest about MACRA in coming months, and so much is at stake. The AAFP is busy decoding complicated language, creating ready-to-use resources, and scheduling time and space for dedicated learning sessions to make sure members are prepared to take the plunge.
In short, the Academy will unequivocally provide the guidance FPs need to simplify this transition so they can reap the benefits of a new payment system that, unlike fee-for-service, values the training, skill level, and yes, the time that goes into taking care of patients in a family medicine setting.
- The AAFP soon will launch a bevy of resources to help family physicians succeed with new payment reform models associated with the Medicare Access and CHIP Reauthorization Act.
- A must-read article just published in Family Practice Management covers details currently known about two new tracks for physician payment: the Merit-Based Incentive Payment System and the Alternative Payment Model incentive program.
- Many of the rules and regulations are still being written, and the AAFP is actively working with CMS to ensure that the proposed rule soon to be released will be good for family medicine.
Stay in close touch with the AAFP in coming weeks as MACRA-related resources roll out -- and consider them your personal roadmap to success.
Get the Facts
Family physicians can start their MACRA journey today by filling up on facts provided by an article just published in the March/April issue of Family Practice Management. In fact, consider this a "must read."
Amy Mullins, M.D., author of the article, "Medicare Payment Reform: Making Sense of MACRA," currently serves as the AAFP's medical director of quality improvement. But in her not-so-distant past, Mullins was taking care of patients at Trinity Clinic, a small family medicine practice in Whitehouse, Texas.
After nearly 13 years of hands-on patient care, she understands the turmoil currently rocking the physician world.
"I've done practice transformation -- just like many of my colleagues -- and it's hard work," said Mullins told AAFP News. "But doing that work -- that kind of homework -- provides a great foundation to prepare for the type of payment reform that's arrived on our doorstep."
Mullins details the two specific payment tracks MACRA lays out for physicians -- the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM) incentive program -- and breaks down crucial timelines.
She delves into the positive and negative payment adjustments associated with MIPS and notes that it is a budget-neutral proposition. "CMS will pay for all of the positive payment adjustments with money it gains from negative payment adjustments," she writes.
That means there will be winners and losers associated with the MIPs track.
"Physicians whose composite scores are in the lowest quartile will automatically receive the maximum penalty for the performance year," Mullins says.
As for the APM track, Mullins describes the various qualifying factors and eligibility criteria, and notes that physicians who participate in an APM could earn a 5 percent annual bonus between 2019 and 2024.
Mullins points out that although the APM track likely would provide participants with more financial certainty, there currently is a shortage of these models. "The number of physicians wishing to participate in these qualified APMs is likely to exceed the supply, at least initially," she writes.
She reminds physicians that even though MACRA provides a framework on which to hang payment reform, the all-important details are currently being crafted in the form of a proposed rule.
"There is still substantial work to be done to define all the rules of MACRA," writes Mullins. "It is at least clear that Medicare will pay physicians based on an assessment of the value of care they deliver to their patients."
Do This Now
Mullins recently talked about MACRA with AAFP News. She's been spending a lot of time traversing the country talking to family physicians about the law and what they need to do to prepare for its implementation.
Is she getting an earful from anxious FPs?
"Family physicians want to know the answers to questions for which we have no answers yet," said Mullins.
"They want to know what certified patient-centered medical home means, what nominal risk means, and what the low-volume threshold will be. The AAFP wants to know, too. Family physicians are asking the right questions; we just don’t have answers for them until the proposed rule is released later this spring."
In the meantime, Academy leaders have been meeting with legislators and federal officials to make sure they understand why the regulations they are crafting must support family medicine.
Regarding physicians' readiness for MACRA, Mullins said they are at the front end of a long learning process.
"Family physicians are still trying to figure out what they can do right now to position themselves to succeed," said Mullins.
In fact, there are several activities you can start immediately to prepare your practice for a profitable transition:
- If you have not been reporting for the Physician Quality Reporting System, it's time to start.
- If that's off the table, you should at least understand how to report quality measures, and the AAFP has resources to help.
- Review your practice's Quality Resource and Use Reports because they will tell you where you stand in the resource use category -- one of four categories that will determine future payments in the MIPS track. "You need to know now if you are a high utilizer of resources because that will count against you," said Mullins.
- Start evaluating your practice in terms of clinical practice improvement activities -- such as access to care, patient engagement and care coordination -- that will be measured when MACRA is implemented.
Mullins expects that many family physicians will move through the MIPS program before they join an APM, and the former can serve as a fertile training ground. "Everything you do in MIPS will prepare you to succeed in an alternative payment model," said Mullins.
She concluded with this final thought: "I sense that some physicians think this whole process will be delayed -- or will even go away. It won't. It's happening. This train has left the station.
"But understand that the AAFP will ensure that family physicians' participation in these programs is as easy as possible and will help them succeed in their efforts."
Related AAFP News Coverage
QRUR 101: Understand, Utilize Quality and Resource Use Reports