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Participation in Medicare Shared Savings Program bodes well for MACRA bonuses, experts say

A top-performing practice could theoretically earn up to a 25 percent payment adjustment in the 2018 performance year, experts say.

Jeff Lagasse, Associate Editor

Participation in the Medicare Shared Savings Program will enhance the performance of the Merit-Based Incentive Payment System, and increase the likelihood of receiving strong performance bonuses, according to a pair of healthcare professionals.

Caravan Health CEO Lynn Barr and LeeAnn Hastings, compliance officer for 23 MSSP accountable care organizations, said in their new issue brief that exceptional performance bonuses are only available the first five years of MIPS. Depending upon the number of exceptional performers, practices could receive up to ten percent in addition to the maximum positive payment adjustment.

Taking into account the Centers for Medicare and Medicaid Services' scaling factor and the exceptional performance bonus, a top-performing practice could theoretically earn up to a 25 percent payment adjustment in the 2018 performance year.

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[Also: MGMA to Seema Verma: Release past-due MIPS eligibility notifications]

"MACRA requires that 30 percent of the MIPS score is based on Resource Utilization," said Hastings in a statement. "Track 1 ACO participants, however, are held accountable for cost in their ACO and not MIPS. As a result, Track 1 ACO participants can more easily achieve high scores compared to other MIPS participants, increasing the likelihood of avoiding MIPS penalties and earning the exceptional performance bonus."

To predict MIPS bonuses, Barr said that clinicians must know both their performance score and estimate the score of the rest of the providers in the MIPS pool. Up to 40 percent of eligible clinicians in the pool are expected to be participants in Track 1 Medicare Shared Savings Program ACOs. Those ACOs will receive special scoring, causing most other MIPS-eligible clinicians to receive lower adjustments in comparison.

[Also: With performance measurement now underway, CMS officials unpack MIPS categories]

"Small practices should consider joining an ACO to avoid penalties for generally lower scores due to lack of infrastructure," said Barr, "and providers in rural areas may want to join ACOs to avoid MIPS penalties due to their higher cost structures. Community hospitals can earn high bonuses and support their community physicians, particularly specialists, by enrolling them in their ACO, protecting their incomes and reducing their administrative burden."

Caravan Health, which currently supports 160 community hospitals and 250 practices in 23 Medicare Shared Savings Program ACOs, is holding weekly webinars to help providers navigate the ACO process and fully understand how to maximize their incentive payments. Participants will receive step-by-step financial guidance on how to calculate potential penalties and bonuses under MACRA.

Twitter: @JELagasse