A look at how the Medicare Access and CHIP Reauthorization Act (MACRA) is driving the shift towards value-based care, but also creating much confusion for doctors about the effects it will have on clinical practices. Lerla Joseph, MD, a primary care physician, notes that “for doctors to succeed in this new environment, they will need to understand the challenges of value-based care and embrace them.”
This means digging into the requirements of CMS and other payers, especially MACRA’s Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). For those participating in MIPS, understanding registries is a critical part of the process. In addition, the article recommends that doctors/practices start reporting at least one quality measurement or activity now, which will help them avoid a four percent penalty in 2019 (for those who don’t report anything in 2017). There may be “easy wins” that practices already do that qualify and would be easy to report with little extra work or data collection.
And finally, physicians will do well to begin the process of fully committing to value-based care now, as “the noncompliance penalty for MIPS increases to 9% by 2023—a substantial hit to any practice’s Medicare revenue. Private payers are likely to create their own incentives and bonuses, if they haven’t already, that may be based on the same quality measures, so a practice’s revenue might be reduced by penalties from them.”
In Delaware, DCHI’s Payment Model Monitoring Committee advocates for the transition of all payers, providers and health systems to a value-based payment model by 2020. Currently, DCHI reports that 30 percent of Delaware’s population is currently attributed to primary care provider or health systems enrolled a value-based payment system. This is more than one-third of the way towards the ultimate goal of having 80 percent of Delawareans in a value-based payment system by 2019. For more information about DCHI’s Payment Model Monitoring Committee please visit us at http://www.dehealthinnovation.org