Making Sense of the Latest MARCA Development

Ally Andrew

Over the past few months, there has been a lot of chatter in the media about the Medicare Access and CHIP Reauthorization Act (MARCA). The new policy makes three important changes to how Medicare pays those who care for Medicare beneficiaries, including ending the Sustainable Growth Rate (SGR) formula, creating a new framework for rewarding providers and consolidating existing quality reporting programs into one. With these changes, providers need to select a system to link quality to payments in the form of Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

That’s a lot of information and change, but here’s the shocking part: according to a July Deloitte survey, 50 percent of physicians had never heard of MACRA! Since the law will affect how providers report patient data and the payment they receive for treating Medicare patients, the pressure is on to learn about the rule and to decide which system to choose.

healthcare_12.pngSource: used under CC license.

Over the past few months MACRA has been evolving, with the most recent development occurring just a few weeks ago when CMS Administrator Andy Slavitt posted a blog in which he granted physicians a “flexible timeline” to implement the rule. Slavitt’s blog outlines four options that providers can select before the fast-approaching deadline of Jan. 1, 2017.

Here is a quick breakdown of the options:

  • Option 1: Test the Quality Program
    • Providers need to submit “some” data to the QPP after Jan. 1, 2017 and showcase that they are preparing for broader participating in 2018 and beyond.
  • Option 2: Participate for Part of 2017
    • Providers can submit QPP information for a reduced number of days after Jan. 1, 2017. This option leaves you open to receiving a small positive payment adjustment because CMS will be able to evaluate the use of technology and improvement activities being implemented.
  • Option 3: Participate for the Full Calendar Year
    • Providers begin participating on Jan. 1, 2017 and submit QPP information for an entire year, qualifying for a “modest” positive payment adjustment.
  • Option 4: Participate in an Advanced Alternative Payment Model for 2017
    • Providers can still participate in QPP by joining an advanced alternative payment model (APM) and if there are enough Medicare payments there could be an incentive payment in 2019 … two years later.

While it's great to have options, it can feel overwhelming to pick just one. Each of these options impacts the amount of payment providers will receive from CMS based on the data they submit, so they need to be prepared to receive a lower payment or no money at all next year. Additionally, the reporting requirements are shifting, so physicians need to be aware of them to ensure they are recording the necessary information during a patient visit. Beyond that, it is crucial that physicians stay educated on this policy and stay on top of developments so that they can make the best decisions possible for their practice.

As PR practitioners, we are constantly on the lookout to create opportunities for our clients to be included in industry conversations that showcase their expertise and educate their stakeholders about important issues. Look no further than the evolving MACRA story to demonstrate the benefit of staying on top of industry trends. By reacting quickly to the latest development, PAN secured media coverage for EHR Client Amazing Charts in target healthcare trade publications such as Healthcare Informatics, MedCity News, and Physicians Practice positioning the brand’s experts as a ‘go-to’ resources for providers to cut through the noise and focus on what to do.

Stay tuned for more on MARCA as CMS plans to finalize the rule this fall. In the meantime, check out how PAN is helping leaders from healthcare IT to the life sciences tell their stories and impact their industries here.

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