Many physicians just catching a breather after implementing systems for electronic health records (“EHS”) but another challenge is awaiting right around the corner.

In 2015, the bipartisan reform legislation called Medicare Access and CHIP Reauthorization Act (MACRA) was passed. The goal of MACRA is to help change Medicare payments from quantity to quality based. Changes begin to roll out in 2017, so physicians need to begin now to understand the new structure. MACRA will consist of two payment structures, Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APM).

A new Advanced Care Information (“ACI”) performance score under MIPS takes away the old “all-or-nothing” scoring and makes up 25% of the MIPS score. The new ACI performance score is designed to make the requirements more simple, support patient care, and be flexible to meet the needs of practices. Physicians are able to select criteria to focus on for their practice and choose which measures best suit their practice.

ACI is only one section of four within the MIPS scoring system. The other three sections include clinical quality, making up 50% of the whole score in the first year; resource usage, making up 10% of the score in the first year; and clinical practice improvement activity, making up 15% of the score in the first year. Adding in the score for advanced care information, for 25% of the total score in the first year, physicians will receive a total score in 2017 that will be used for payments in 2019.

The physicians who perform best will also be qualified for bonus payments of up to 10% from 2019 to 2024. Physicians scoring below a certain threshold will see opposite changes to their payments. Penalties will range from a maximum 4% in 2019 to 9% in 2022 and beyond.

Independent health care practitioners are faced with many challenges in today’s ever changing environment. Changes in payment models and reimbursement methods, competition with a large group of employed physician practices, and changes in patients’ insurance coverage can negatively impact practices’ bottom line if physicians do not stay focused on financial performance of their practices. In order to continue to be successful, practices should commit to staying on top of new regulations and effective implementation of them as well as using best practices for cash flow management. Call us at 407-650-9088 to set up a FREE consultation on how we can help you stay on top of these and other regulations.