MACRA is a disruptive, regulatory program to existing physician reimbursement with many elements and moving parts. It transitions providers away from traditional fee-for-service and introduces revenue gain or loss based on key value-based metrics.
What is MACRA?
MACRA makes three important changes to how Medicare pays physicians who provide care to Medicare beneficiaries. These changes include:
- Repealing the sustainable growth rate (SGR) formula for determining Medicare payments for healthcare providers’ services
- Creating a new framework for rewarding healthcare providers for giving better care
- Combining existing quality reporting programs into one new system.
The difference between top and bottom performing hospitals may be an increase or decrease of $4 million in Medicare Part B revenue.
The program includes two new Quality Payment Programs, the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), both of which go into effect over a timeline that started in 2015 and goes through 2021 and beyond.
Physician Medicare payments will now be determined using a composite score based on quality, resource use, meaningful use and clinical practice improvement measures with the opportunity to receive significant incremental reimbursement for positive scores.
What does this mean for your organization?
Based on your readiness for MACRA, if you have selected the MIPS path (not APM) you have the opportunity to impact Medicare Part B revenue by 4 percent or more depending on performance. If you do nothing, you will see MACRA penalties of a 4 percent decrease of total Medicare Part B revenue. For a physician group or hospital with $50 million in Medicare revenue, that is a $4 million swing between top and bottom performing hospitals.
Steps to a proactive solution
To be successful in this new value-based world and to reap incentives provided by CMS, organizations must be proactive and develop a MACRA readiness plan. Baker Tilly will work with your organization to develop a solution that optimizes performance within these new metric requirements. Our MACRA readiness solution begins with a complete financial and operational assessment and leads to a strategic MACRA roadmap for the success of your organization moving forward.
Baker Tilly’s MACRA readiness solution
- Financial readiness assessment
- Operational readiness assessment
- Gap analysis
- Strategic roadmap
- Implementation and performance monitoring