CMS’s MACRA will affect anesthesiologists in several ways, including the alternative payment model criteria, which are very stringent. Most anesthesiologists won’t be able to meet the requirements initially, according to an Anesthesia Business Consultants report.
Eligible clinicians will participate in the Merit-Based Incentive Payment System or Alternative Payment Model incentive under the physician fee schedule as the Physician Quality Reporting System and Value-Based Modifier program, as well as the EHR Incentive-Meaningful Use programs are phased out. MIPS and APM begin on Jan. 1, 2019 with payments reflecting participation in the programs based on the clinician’s performance in 2017.
Here are five key notes:
1. The APM incentives are for payment years 2019 to 2024, a lump sum payment equal to 5 percent of the estimated aggregate payment amount for Medicare Part B the prior year. Payment years 2026 and later will have rates under the Medicare physician fee schedule updated by 0.75 percent.
2. To quality for APM the individual clinician must participate in Advanced APM, which are narrowly defined. Most clinicians won’t participated in Advanced APM, where clinicians accept both risk and reward for providing coordinated, high-quality and effective care.
3. APMs that want to qualify as Medicare Advanced APMs or Other Payer Advanced APMs must meet all requirements:
• Certified EHR use
• Covered professional services payment based on quality measures comparable to MIPS
• Bear financial risk for monetary losses in excess of a nominal amount or be a recognized accredited patient-centered medical home
4. APMs must bar financial risk under MACRA requirements but CMS hasn’t defined the amount of risk. The agency currently proposes a “generally applicable financial risk standard.” The risk must be more than nominal but not excessive.
5. CMS estimates that in 2019 between 30,658 and 90,000 eligible clinicians would become qualified professionals through Advanced APM participation. These clinicians will receive between $146 million to $429 million in incentive payments.