Conference Coverage

MACRA advice: Do the MIPS bare minimum this year



– Confused about what MACRA, MIPS, and APMs mean for you and your practice this year?

Clifford Lober, MD, offered some very simple advice at the annual meeting of the American Academy of Dermatology: “If you take nothing else from this annual meeting – not this session, but the whole meeting – submit one quality measure or one improvement activity or the required advancing care information base measures – one time, on one patient” to the MIPS program, Dr. Lober said. “If you do that, you will save 4% of your Medicare payments in 2019.”*

Dr. Clifford W. Lober

Under the Quality Payment Program (QPP), established by MACRA (the Medicare Access and CHIP Reauthorization Act of 2015), all physicians – as well as other providers – will be paid by Medicare through either an advanced Alternative Payment Model (APM) or the Merit-based Incentive Payment Program (MIPS) going forward. Almost all dermatologists will end up in MIPS, the default system, as only about 2%-5% of dermatologists are qualified providers in advanced APMs, Dr. Lober said.

MIPS is a system of bonuses and penalties based on data the Medicare program started collecting on Jan. 1, 2017; it incorporates the legacy quality measure reporting systems including the Physician Quality Reporting System, meaningful use, and the value-based modifier program, said Dr. Lober, a dermatologist in private practice in Kissimmee, Fla.

Based on feedback from physicians and other stakeholders, Medicare announced last fall that physicians could “pick their pace” as to how they wanted to report data to MIPS in 2017, the first baseline year of the program. They could:
  • Choose to not participate. These physicians will see an automatic 4% reduction in their Medicare payments in 2019.
  • Test QPP. Report on one quality measure or improvement activity for one patient. Of note: This information does not have to be submitted electronically; paper submission is okay. These physicians will avoid the 4% Medicare pay cut.
  • Participate for part of the year. These physicians will report for 90 consecutive days of their choice on more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category. Reporting must start before Oct. 2, 2017. These physicians may earn a pay increase.*
  • Participate for the full year. Submit a full year of data to Medicare. These physicians may get a pay increase.

Dr. Lober said pointedly, “The first choice – doing nothing – is the dumbest move you could make.”

He also noted that the CMS regulations say verbatim that “positive adjustments are based on data on the performance information submitted, not the amount of information or the length of time submitted.”

A few physicians and other clinicians are exempted from the QPP for 2017. Those who are in their first year of participating in Medicare Part B are exempt, as are those who bill less than $30,000 or have fewer than 100 Medicare patients.*

“The low-value exemption alone, CMS actuaries think, will exempt 32.5% of clinicians in the United States – a huge exemption,” Dr. Lober said, adding that when it comes to dermatologists, it’s estimated that about 18.3% will be exempt from MIPS.

Despite the new political landscape in Washington, Dr. Lober said that he does not think MACRA will go away.

“One of the things I want to say out front is, what is the likelihood of MACRA being repealed?” he said. “Somewhere between slim and none or even none and none. It was supported by both Democrats and Republicans and I think it’s here to stay. It might be modified, but it’s here to stay.”

He urged physicians to reach out to CMS if they have comments about the MIPS, APMs, and the Quality Payment Program, noting that despite the formal comment period being closed, agency officials have been receptive to comments and suggestions.

*This article was updated on March 13, 2017 at 3:30 p.m.

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