The pMD Blog

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where we cover interesting and relevant news, insights, events, and more related to the health care industry and pMD. Most importantly, this blog is a fun, engaging way to learn about developments in an ever-changing field that is heavily influenced by technology.

How To Make The Best of CMS Payment Incentives
One thing that we can predict with certainty in the health care industry is new acronyms. And new acronyms can mean changes to CMS payment programs. It was approximately one year ago that my colleague Elise wrote a great article on the Physician Quality Reporting System (PQRS). PQRS was originally an incentive based program which, in 2006, included a 1.5% incentive payment based on total allowable charges to providers who reported quality information to CMS. In 2008, the Medicare Improvement for Patients and Providers Act (MIPPA) extended PQRS and increased the incentive to 2%.

This incentive continued until 2010 when the Affordable Care Act (ACA) introduced penalties for providers who did not submit PQRS data. The introduction of penalties forced providers to rethink how they were submitting PQRS data in order to ensure they wouldn't see their levels of reimbursement decline. Participating providers were forced to adopt additional software solutions, employ additional specialists, or join PQRS registries (like us!) in order to not be penalized.

Fast forward to 2016, and after 13 years and over $150 billion spent, the Sustainable Growth Rate (SGR) formula is being eliminated! The Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law by the President on April 16, 2015 and completely revamps how CMS pays providers.

According to MACRA, we are now in a transition period whereby:

• Physicians will receive annual growth fee schedule rate increases of 0.5% starting on July 1st, 2015 through the end of 2018.
• There will be a 2% penalty for failure to report PQRS measures.
• There will be a 3% penalty for failure to meet meaningful use requirements.
• The rates in 2019 will be effective through 2025 and providers will have the opportunity to receive additional payments through the 'Merit-Based Incentive Payment System' (MIPS).

Compare the MIPS incentive payments to the SGR formula of a 21% cut in reimbursement, and you can see why the American College of Physicians is in complete support of MACRA and MIPS.

The most surprising provision in MACRA, however, is the fact that CMS is now required to replace not only the SGR, but also PQRS, the Electronic Medical Record Incentive Program (Meaningful Use), and the Value Based Modifier program by 2019 with MIPS.

The AMA and the ACP both agree that the MIPS program is a positive development for physicians as it allows them to effectively determine their eligibility for incentive payments beginning in 2019.

pMD is getting set to help our providers proactively set their performance goals and get credit where credit is due! Check back for part two on MIPS where I describe how pMD helps our providers in the four MIPS assessment categories which will be crucial to receiving positive MIPS adjustments in 2019.