December 2, 2016 Conference


Impact of MACRA on Ophthalmology

Dr. William Rich III (Presenter)
Speaker Session Topic
When physicians and health policy mavens are asked to name the Federal legislation with the greatest impact on domestic retinal practice most would suggest the passage Medicare in 1964. Yes, Medicare greatly expanded access to the elderly and the disabled, increased physician revenues, and stimulated investment in new technology. However, it had little disruption on day-to-day practice. In reality the 2015 passage of the Medicare Payment and CHIP Reauthorization Act (MACRA) is far more impactful. The MACRA (aka as the SGR fix bill) Notice of Propose Rule Making published in the Federal Register in April of 2016, if implemented as written, will dramatically change the practice and reimbursement for all US physicians. New MACRA policies include: ? Repeal of the sustainable growth rate (SGR) methodology ? +0.5% updates for 5 years (retinologists will never see a $1!) ? Fundamentally changes the way Medicare determines and updates payments to physicians. MACRS has two major goals. First, the elimination of traditional fee for service with future payments based on the ability of physicians to provide services under risk contracts. The proposed revenue targets or patients from risk contracts (alternative payment models) are 25% in 2019, rising to 75% in 2013. Sheer fantasy. Second, an emphasis on improvements in the “quality of care” by measuring physician performance on quality reporting, use of information technology, clinical practice improvements and cost. MACRA provides two pathways to avoid cuts and achieve bonuses: participation in alternative payment models (APMs) and MIPS (Merit Based Incentive Payment System). The schedule of payment bonuses and penalties is outlined in the legislation. • Adjustment factor plus or minus: – 2019 4% – 2020 5% – 2021 7% – 2022 9% Physicians with less than 100 Medicare patients and $10,000 in charges are excluded. That would cover zero retinal specialists. The APM pathway transfers financial risk from the US Treasury and Medicare Trust fund to physicians by incentivizing the development and physician participation in risk contracts called Alternative Payment Models (APMs). APMs provide a yearly 5% bonus on Medicare payments from 2019 to 2024 that then decreases to 0.75%. However, there are no APMS available for the retinal specialty. For ophthalmologists the MIPS pathway is the only viable option. MIPS is a complex program that measures your performance in following four areas with weights in 2019 based on 2017 performance. -Quality measures 50% in 2019 -Cost (Resource use) 10% in 2019 -Clinical practice improvement 15% -Advancing Care Info.(MU) 25% Weights can change over time. When 75% of eligible professionals achieve MU (meaningful use) the weight could be reduced to 15% to emphasize other categories. Resource use will increase to 30%. The presentation will delineate how ophthalmologists integrated with the AAO IRIS Registry are positioned to navigate and succeed in the incredibly complex changes mandated by MACRA.