Optical Resources: Understanding the Two Tracks of MACRA

Posted by Jeff Rezabek on Thu, Sep 08, 2016 @ 15:09 PM

Change in the eyecare industry can be tough to manage, especially when you have other aspects of your business to worry about. And just when you think you might have it all figured out, there is another change that will alter the way your practice generates revenue.

This change, of course, is The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA.

A lot of optical resources have been written about these changes, but how prepared are you? This post gives you a quick overview of MACRA and its two payment tracks.

The Two Tracks of MACRAoptical resources

MACRA is a new reimbursement model that is designed to cut down on overtreatment practices by introducing a value-based payment model.

MACRA changes Medicare payments in three important ways, which the Centers for Medicare & Medicaid Services (CMS) calls the Quality Payment Program (QPP).

These three changes include:

  1. Replacing the Sustainable Growth Rate (SGR) formula with a new payment model.
  2. Designing a new payment framework that rewards healthcare providers for giving patients quality care that they actually need.
  3. Combining three quality reporting programs into a new system.

These changes will create a more flexible system that will allow you to choose from the two payment tracks, MIPS and APMs.

Track One: MIPS

The Merit-based Incentive Payment System (MIPS) lumps the Physician Quality Reporting System (PQRS), Value Modifier (VM), and the Medicare Electronic Health Record (EHR) Incentive Program together into one new system. This new single program will measure Eligible Professionals (EP) on four categories:

  • Quality
  • Resource Use
  • Clinical Practice Improvement Activities (CPIA)
  • Advancing Care Information (ACI)—formerly known as Meaningful Use

The four categories make up a 100-point scale known as the Composite Performance Score (CPS) with the quality category making up 50% of the score.

What you need to know about MIPS

Eligible Professionals (EP) may receive payment increases, payment decreases, or no payment at all. MIPS has a two year look-back for payment adjustments. For the 2017 reporting year, the payment adjustment will be at +/- 4% in 2019. These payment adjustments will grow to 9% by 2022. But, there is a chance that you can receive up to 3x the maximum positive performance adjustment depending on the positive and negative adjustment ratios.

Track Two: APM

The Alternative Payment Model (APM) incentive introduces alternative ways for doctors to receive payments. According to CMS’s Quality Payment Program slide deckslide deck, an APM can include:

  • A CMS Innovation Center model
  • The participation in the Medicare Shared Savings Program (MSSP)
  • A demonstration under the healthcare quality demonstration program
  • An involvement in other demonstration programs that are required under federal law

To qualify for the Advanced APM track, you have to use a certified EHR technology and be more susceptible to normal financial risk or qualify as a Medical Home Model.

What you need to know about APM

Participants in the APM track may receive a 5% annual bonus and will be exempt from MIPS.

Stay tuned, the final ruling on MACRA is expected to be published on November 1st, 2016.

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