2016-04-28 15:13:36 UTC

April 28, 2016

MACRA will revolutionize key programs that determine Medicare reimbursement.

As we alerted members on April 27, CMS released the long-awaited proposed rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA). The most important thing you can do now is to become more familiar with the programs under MACRA and begin to prepare for the changes it will mean for your practice.

In case you missed that alert, here’s the full text and below we’ve included a few interesting stats on the potential impact to GIs. 

  • CMS will roll out the comprehensive Merit-based Incentive Payment System (MIPs) and incentivize the use of alternative payment models (APMs). Services provided beginning on Jan. 1, 2017, will directly impact reimbursement provided in 2019, the first year in which the MIPS program and APMs are effective.
  • CMS expects that 1,849 gastroenterologists will be excluded from MIPS. These GIs will be excluded because they participate in alternative payment models or see fewer than 100 Medicare Part B-eligible patients and bill less than $10,000 to Medicare.
  • CMS projects the majority of GIs (61.5 percent) who participate in MIPS will receive a bonus. Positive payment adjustments are projected to be about $34 million for GIs. Unfortunately, this increase would be partially offset by negative payment adjustments for 38.3 percent of GIs. Nearly 60 percent of colorectal surgeons are also expected to receive a positive adjustment.  
  • The larger the practice, the more financial upside. According to CMS data, the likelihood of receiving an upward performance adjustment increases as the practice size increases. Among practices with two to nine eligible MIPS clinicians, only 29.8 percent are expected to receive a positive adjustment. This number increases to 81.3 percent for practices with 100 or more. Solo practitioners will be hit hardest by MIPS, with 87 percent likely facing a negative adjustment totaling a loss of $300 million for solo practices across all specialties.

AGA is reviewing the 962-page regulation now and will release a deeper summary of key provisions and how you can prepare. We have an opportunity this summer to comment on the rule and advocate for changes. Read more about the MACRA proposed rule.

More on MACRA