January 1, 2017 marked the first year of the Medicare Access and CHIP Reauthorization Act (MACRA) rollout. More than halfway through the first performance year, many specialists are still trying to navigate participation, and one of the main questions is which payment track to take.
MACRA, which was signed into law in 2015, was established to accelerate efforts to reimburse Medicare clinicians based on quality of care, instead of volume of care. To comply with the law, physicians need to enter one of the two Quality Payment Program (QPP) value-based payment tracks: MIPS or an Advanced APM.
Track 1: MIPS
The first track is Merit-based Incentive Payment System (MIPS), a payment system with an incentive bonus or penalty for reporting or failing to report certain quality measures. The track requires reporting in four performance categories: quality; advancing clinical information through health information technology; clinical practice improvement activities; and costs.
Track 2: Advanced APM
The second track is an Advanced Alternative Payment Model (APM). For specialists, bundled payments including the upcoming Bundled Payments for Care Improvement (BPCI) Advanced will qualify as an Advanced APM. Under MACRA, participants who meet required thresholds based on a portion of their revenue or patients covered under the Advanced APM would receive an automatic 5% payment bonus on all of their Medicare revenue with the opportunity to earn even more if they achieve savings targets.
Compensation of clinicians in the first payment year, 2019, will be based on performance in one of these two QPP tracks. While small physician practices with less than $90,000 in Medicare and fewer than 200 Medicare patients are exempt, nearly 40% of clinicians across the country will automatically be entered into track one, MIPS.
For many specialists, this likely isn’t the best option for their business or their patients. Of the two tracks, an Advanced APM is more enticing for specialty-focused providers. While the physician is forced to accept more risk with an APM, there are clear financial benefits. The qualifying participants in an Advanced APM receive a payment bonus, regardless of their performance and savings. The MIPS model, on the other hand, offers limited potential for payment increases with more competition.
MIPS also requires more onerous reporting on behalf of clinicians. In a study completed by KPMG, 90% of respondents that have said they are participating in MIPS in 2017 reported that the requirements are burdensome. Two-thirds of respondents also expressed concerns about the time required to report for MIPS, and nearly half believe that the time requirements for reporting will remain a significant challenge going forward.
The Next Opportunity For Track 2: BPCI Advanced
With the upcoming announcement of BPCI Advanced, specialists have an opportunity to position their organization to earn more revenue and avoid burdensome reporting.
BPCI Advanced is the next generation of the original BPCI initiative created by Medicare, and the first new Medicare bundled payment opportunity for specialists since early 2014. The program is anticipated to launch in the summer of 2017, and participation will result in exclusion from MIPS.
With MACRA’s QPP underway and the first payment year fast approaching, specialists should plan and determine which track their organization will pursue. At Archway, we believe BPCI Advanced is not only the better option under MACRA’s QPP, it’s a better business solution. Bundled payments can help grow your practice, and Archway is the partner to help you navigate these bundled payment programs.