On Oct. 14, CMS unveiled the final Medicare Access and CHIP Reauthorization Act rule, which will outline physician Medicare payment fees following the sustainable growth rate formula repeal.
Kyna Fong, CEO of San Francisco-based Elation Health, offers her insight into how this finalized legislation will impact independent physicians.
"I think MACRA is the centerpiece or inflection point from fee-to-service to value-based payment," says Ms. Fong.
CMS listened and acted upon concerns surrounding MACRA, offering flexibilities in the final rule:
- Physicians may test the Merit-based Incentive Payment System by reporting "some" quality and cost data in 2017, with the intent of immersive participation in 2018 and 2019.
- Physicians in MIPS may submit complete quality and cost data for a portion of 2017, avoiding a penalty and possibly earning a 2019 partial positive payment adjustment.
- Physicians may submit performance data for the full 2017 calendar year.
- Physicians may participate in an Advanced Alternative Payment Model.
"The multiple options [in MACRA] label 2017 as a transition year and set a low threshold for getting a positive payment," Ms. Fong adds. The final rule increased the low-volume threshold to $30,000 in Medicare Part B charges or 100 Medicare patients.
This transition year extends the timeline for smaller practices to get their resources in order for success under MIPS or Advanced APMs.
The new year will present a new load of administrative work for practices, but successful practices will leverage technology to ease the burden.
"Physicians need to have technology, that first and foremost, is enabling them to deliver better care and not just a glorified administrative tool," says Ms. Fong. If a practice invests in technology that is clinical in nature, physicians will likely not find the reporting so onerous.
"The more aligned [the technology] is with the care you're providing — that's the kind of technology that physicians need," she adds.
Down the line, virtual groups may also present a significant advantage for smaller practices. Although CMS announced it will not implement virtual groups in 2017 in order to establish technology infrastructure, MACRA will allow practices with 10 or fewer clinicians to combine reporting for a larger patient population, down the line.
The intent of virtual groups is to boost smaller practices to the level of larger practices, by sharing resources and technology investments. Ms. Fong hopes virtual groups will be up and running by 2018.
"The reason [virtual groups] jumps out to us, is we already do that with our platform," Ms. Fong says of Elation Health. "We allow our practices to collaborate on a longitudinal patient record that's shared between them."
Elation Health provides a real-time version of a patient's record to every physician caring for the patient throughout his or her episode of care, across separate organizations.
"[Our platform] pretty much gets at the heart of interoperability and care coordination across providers, as the average physician shares patients with about 229 other physicians," says Ms. Fong. Elation allows physicians to connect by exchanging information and messages without consolidation in one facility.
"That's important and powerful in a world where we want more reporting at point of care, but we don't want to dictate how care is delivered," Ms. Fong adds.
Even though practices can't engage in virtual groups next year, Ms. Fong suggests they consider how to participate in the future.
Additionally, she advises smaller practices to not disregard APMs, as they may be more attainable than initially thought.
"CMS is expanding opportunities for providers to participate in advanced APMs, which offer increased payment and bonuses, because that's where they want to encourage [practices] to go," Ms. Fong concludes.