QUESTION:        What’s the current timetable for the proposed changes in physician reimbursement required by MACRA?

ANSWER:            No one is really sure yet, but right now it is supposed to go into effect on January 1, 2017. The Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) was signed by the President on April 16, 2015.  CMS issued proposed regulations on April 27, 2016. According to CMS, MACRA makes three important changes to how Medicare pays physicians:

• Ends the Sustainable Growth Rate (“SGR”) formula for determining Medicare payments.
• Establishes a new framework for rewarding health care providers for giving better care, not just more care.
• Combines existing quality reporting programs into one new system.

Final rules are expected by November, but there is a lot of talk that they might be delayed.  During a July 13 U.S. Senate Committee on Finance hearing on MACRA, CMS Acting Administrator, Andy Slavitt, left open the possibility that it could be pushed back from the intended start date of January 1, 2017.

Once MACRA does go into effect, physicians will have to choose between two different reimbursement models:  the Merit-based Incentive Payment System (“MIPS”) – the default system – or the Quality Payment Program (“QPP”), which requires participation in an Alternative Payment Model (“APM”).  Depending on which program is selected and how the physician performs, Medicare reimbursement can go up or down by a significant amount.  CMS has published a handy timeline to show how this will play out over the next several years.

The details of MACRA are far too intricate to describe in this short piece.  Suffice to say that it will radically change how physicians practice, whether they are on their own, in an independent group or employed by a hospital or health system.

If you want to know more about MACRA, come to Horty Springer’s Physician-Hospital Contracts Clinic in Las Vegas on October 13-15, 2016.  We’ll be discussing how MACRA will work and what you might want to consider changing with respect to physician employment contracts and compensation models, and how MACRA will change the relationship between physicians and hospitals in the future.  Click here to register.