AMA president David Barbe discusses the pros and cons of MACRA and MIPS. Photo via YouTube
With the Merit-Based Incentive System and the Medicare Access and CHIP Reauthorization Act, the federal government is beginning to harmonize programs to simplify reporting, decrease the number of measures and potential penalties – and adding an upside opportunity for the solid performers.
"We have a better framework to go forward," said David Barbe, MD, president of the American Medical Association and a family physician from Mountain Grove, Missouri. "It's increasingly looking at the value that care brings. That can be in terms of economic savings. It can be in terms of improved quality. It can be in terms of better interaction between physicians and patients."
Barbe also acknowledged that the road to getting doctors and healthcare organizations large and small on-board might make for a bumpy ride.
MACRA and MIPS better than meaningful use
While Barbe said that the meaningful use EHR incentive initiative was "a dream program" that was not exactly workable for doctors, MACRA and MIPS are more feasible.
"When 80 percent of doctors have certified EHRs, but only 12 percent can fully attest, that's a program problem. That's not a doctor problem," Barbe said. With the new MACRA and MIPS quality reporting initiatives, the government "packages them in a way that is more rational and somewhat easier for physicians to report."
The goal for MACRA and MIPS, as he sees it, is to simplify the reporting, decrease the number of measures, lower the potential penalty – and reward the better performers.
Another positive is that CMS is eager for physicians to get engaged in this program and be successful, Barbe says, noting that the AMA and other organizations worked with CMS to create a path for physicians to begin to more gradually transition to MIPS.
The Pick your Pace Program allowed some struggling physicians to report on a single quality measure for one patient. Reporting that one measure helped them dodge the penalty for the first year.
"This is a program framework that should make it easy to participate," Barbe said.
"If you have any interest at all in participating, you should at least do that. Then you can perform at a higher level if you're prepared to do so."
Physicians are also able to get further exemptions for low-volume practices – it's called the low-volume threshold.
"We proposed that be raised so the practice would have to be a little bit larger before it would be required to participate in MIPS," Barbe said. "It looks, in fact, that for 2018, they may even raise that further. If they do, it would make more practices exempt from participation in the program."
The AMA and other organizations convinced the government that small and rural practices needed some leeway, especially for some smaller practices or for physicians approaching the end of their career, where return on investment is just not there.
For 2017, practices that have fewer than 100 Medicare patients or less than $30,000 in Medicare billing are exempt from the program.
Unrealistic expectations ahead
Physician burnout. That is among the most discussed problems since meaningful use started and in lockstep with the lead-up to ICD-10. MACRA and the Quality Payment Program have their own issues and problems, Barbe said, notably that many physicians are having trouble getting their heads around the changes.
Looking into the future, Barbe said the AMA and other industry associations have work left to both address physician burnout and ensure that anyone who wants to participate in the new programs can actually do so.
"As the law is written, in 2019 we need to be up to full implementation of this program," Barbe said. "This is the biggest shift that we've seen in over a generation. So to expect us to ramp up even in a couple of years might not be realistic."
The AMA and other physician organizations are concerned that even in 2019 there might be some practices that are still not ready in spite of their best efforts. AMA, for its part, continues to work with CMS and Congress to look at 2019 and beyond to determine what reasonable accommodations should be made that would allow physicians to transition into the program.
"What we are advocating for is that there are practices ready to participate. They have invested in the infrastructure necessary," Barbe said. "And we'd like for them to have the option to opt into the program."