Top three things you need know about MACRA

We sat down with David Heller, the Industry and Government Affairs Manager at Greenway Health, to discuss recent updates for MACRA.

1. What has changed in the Centers for Medicare and Medicaid Services final rule for MACRA for 2018?

First, CMS added an exemption from MIPS for practices that have been impacted by natural disasters. Practices will not need to apply for an exemption because CMS will qualify practices automatically. The next big change is bringing Cost in at 10 percent. This will be measured by looking at spending per Medicare beneficiary. CMS shifted here because they felt going from 0 percent to 30 percent in 2019 would have been too abrupt. The other large shift was the expansion of the low-volume thresholds. While we expected that provision to finalize, it is still significant because it excludes large numbers of clinicians from the program.

David Heller, Industry & Government Affairs Manager
David Heller, Industry & Government Affairs Manager

2. What do doctors need to do for 2018?

It depends on their clinical and financial goals. I generally see organizations fall into one of three buckets:

  • Practices that want to just comply and avoid a penalty.
  • Those that are trying to transition their practice and start with some change management.
  • Practices that really want to excel and go after significant incentive payouts.

In 2018, the performance threshold, or the score you need to earn to avoid a penalty, is set at 15. That means there’s a variety of ways you can avoid a penalty. You could report on six quality measures while meeting data submission thresholds, or you could fully participate in Clinical Practice Improvement Activities. Those seeking to earn an incentive should focus their efforts on crossing 70 in the composite score. MIPS is designed to be budget-neutral, except for those who are exceptional performers in the first few years of the program. Because the threshold is so low, there are not as many penalty dollars in play, so to earn a substantial incentive, it’s best to think about how to be one of those exceptional performers.

3. What is going to happen in 2019?

There are two statutory provisions in MACRA that will be implemented in 2019:

  • First, Cost will be weighed at 30 percent. That’s a huge jump.
  • Next, in 2019 the performance threshold will be set at the mean or median of prior years’ scores. That’s going to significantly ratchet up the pressure to perform for many groups.