Most physicians are not realizing the financial impact of MACRA and the Quality Payment Program (QPP).

A recent survey showed that most physicians in the U.S. are not aware of the huge cliff they will be running off if they choose to ignore the new  "voluntary" Quality Payment Program (QPP) that went into effect January 1, 2017. Most Medicare providers, even those who were immune to Meaningful Use, will leave 8 to 18% of their Medicare fees on the table over the next 5 years, costing them tens of thousands of dollars in revenue. And some think that it will all go away with Obamacare, or "I can do the minimum by year's end and avoid the penalties." Even the latter strategy, however, has the potential of costing them a bonus of up to 4% as compared to starting today with a strategy. The options and financial impacts are displayed below.

The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) was established by the Senate by a bipartisan (92-8) vote in 2015. MACRA eliminated the annual "physician fix" to the Medicare budget. It impacts doctors who do office/clinic visits,  surgery/procedures and telehealth visits. So by definition, it will impact many physicians who were excluded from the Meaningful Use program, such as Interventional Radiologists and Pain Specialty Anesthesiologists. It does excludes low-volume Medicare providers (those who have less than 25 of the qualifying visit codes per year). 

MACRA established a static rate of Medicare fee growth of 0.5% through 1022 and a "budget neutral" program to reward those physicians who participate all this year with the QPP at the expense of those who do not.  There also is a program for physicians who have already created innovative models of practices such as federally-approved Patient-centered Medical Homes (PCMH), Accountable Care Organization (ACO) models and a variety of carve-out exclusions from oncology (cancer) care to end-stage renal disease (ESRD) programs.  These physicians will apply to be paid even higher bonuses under the Alternative Payment Model (APMs) of the QPP.  The vast majority of physicians will either do nothing (and receive a 4% across the board reduction) or participate with the Merit-based Incentive Payment System (MIPS) or do the "MIPS at my pace" program that will avoid the penalties for 2019.  Let's look at the financial impact of these three MIPS options:

FINANCIAL GAIN OF FULL 2017 MIPS PARTICIPATION 

FINANCIAL GAIN OF FULL 2017 MIPS PARTICIPATION 

Start MIPS Now

This option is the best financial model for doctors who want to potentially capture the whole 4% bonus offered by MIPS.  You will need to capture points in the four areas of improvement:

  • Quality (replaces PQRS)
  • Advancing Clinical Care (replaces Meaningful Use)
  • Clinical Practice Improvement
  • Cost/Resource Use (replaces the value-based modifier)

Each is weighted to 50%, 25%, 15% and 10% respectively in 2017 and you will need to score enough "points" to get into the top bonus tier.  If you aren't participating in an APM, we encourage you to start with your MIPS planning today. This could be the best opportunity this decade to capture an increase in your Medicare fees for be recognized for improving patient outcomes.

FINANCIAL IMPACT OF Starting later in "MIPS AT MY PACE"

FINANCIAL IMPACT OF Starting later in "MIPS AT MY PACE"

MIPS At My Pace

This option is only available in 2017 (which is deemed a "transition year"). Physicians must start by October 1, 2017 to qualify.  It allows physicians or medical practices to submit less than a full-year of participation in MIPS.  If they score a minimum of 3/100 points they will not be in the "penalty pool" and may, based on performance, even get a small bonus (based on the benchmark all all MIPS participants this year. Those scoring 70/100 or higher will share in a pool of $500 million. Regardless they will get the 0.5% Medicare raise each year, but are likely to miss out on substantial bonuses. It is probably never wise for a physician to leave CMS money on the table. It is also unwise that you are excluded from the "voluntary QPP" and therefore will not start "until I find out more."

Financial IMPACT OF NO PARTICIPATION WITH QPP

Financial IMPACT OF NO PARTICIPATION WITH QPP

Skip MIPS Participation

This will be the fate of physicians who do not volunteer to participate in the QPP.  Essentially, they are missing out not only on a bonus, but receiving penalties for their inaction in 2017 and beyond.  The penalties occur two years later than the performance and accelerate over 5 years as follows:

  • 4% in 2019 for 2017
  • 5% in 2020 for 2018
  • 7% in 2021 for 2019
  • 9% in 2022 for 2020

Thus the opportunity cost of Potential Bonus - Potential Penalties is as follows:

  • 8% for 2017
  • 10% for 2018
  • 14% for 2019
  • 18% in 2020

Don't get caught in this category. Contact us today.