From meaningful use to MACRA: What you need to know now

Stephen R Permut, MD, JD , Former Board Chair

A new quality reporting and payment system for Medicare is on its way. As physicians we need to understand the choices we will make about participation. This change has been a long time coming, and it will take physicians leading the way to make sure it is a step in the right direction.

Thanks to years of advocacy efforts and physician voices on the matter, we were able to secure passage of the Medicare Access and CHIP Reauthorization Act (MACRA) early in 2015. This legislation repealed the sustainable growth rate (SGR) formula and creates the opportunity for making significant changes to the meaningful use program. 

And through our Break the Red Tape grassroots campaign—which to date has featured three town halls on electronic health records (EHR) and meaningful use and collected thousands of physicians’ testimonies—the AMA was able to secure several key regulatory changes after the defeat of SGR.

The important thing about these changes is that all were physician-led. The implementation of MACRA must also be physician-led if we want to secure a future that is designed for physicians and patients, rather than by insurance companies.

As a result of our efforts, CMS Acting Administrator Andy Slavitt in January said that the agency is changing its culture to focus on physician and patient needs. Then in February, Slavitt took this one step further, pledging that CMS would partner with physicians to create a system that is patient-centered, focused on reducing the administrative burdens on physicians and designed to support changes in care delivery. 

This partnership with CMS is critical to the future of medicine. As physicians we should not be spending our time on the computer clicking our way through the day. We are healers; our energy should be focused on spending time at the bedside listening to patients. The fact that CMS has vowed to work with physicians on this new program is a significant turning point. 

As we move forward, it is important for physicians to understand what our choices are: Do you want to participate in the fee-for-service model under the new merit-based incentive payment system (MIPS) or participate in alternative payment models (APM)? The important thing is that we have a choice. Physicians from all specialties and practice types will have choices in the kinds of models in which they participate. 

If you elect to participate in the MIPS, the composite MIPS score will take into account four categories:  quality, resource use, EHR meaningful use and clinical practice improvement. 

Under the MIPS, the aggregate financial risk is less than under the previous Medicare quality and reporting programs. The old pass-fail approach to all these programs will be eliminated, and physicians will have the chance to earn bonuses if they score above average performance thresholds. Physicians who meet the threshold requirements but don’t exceed them still will avoid penalties. The MIPS also will give physicians the chance to score better and receive more credit for additional quality improvement efforts—including a new category of clinical practice improvement activities—than under the current programs.

Should they choose the APM option, physicians can take the lead by working with their specialty societies to develop payment models appropriate to their specialty. By participating in a qualified APM, physicians will be subject only to quality reporting requirements for their specific payment model and will not be subject to the MIPS.

Well-designed APMs can allow physicians to provide better care to their patients, lower health care costs and improve their financial bottom line. 

I am optimistic that we are going to end up in a better place, but securing these options means that we can direct our future—we can design payment models that work for us and our patients and always have fee-for-service under the MIPS as our safety net. In the end, both options really need to be user friendly, which is why it’s so important that the AMA is continuing to get the physician voice in front of key policymakers. 

What is important for physicians now is that we understand these options as more information becomes available. We will know the material and know our options because these changes will determine the course of the future for our practices and our patients.