A majority of physicians are aware of the Medicare Access & CHIP Reauthorization Act (MACRA), and those who do know about it probably want it to go away. Nevertheless, this law will determine how Medicare pays doctors, starting in 2019.  Some modifications in the rules from those published in July 2016 will make things considerably easier for doctors, but physicians need to start getting ready for MACRA immediately.

Under CMS’ original proposal, physicians would have had to report on their performance for a full calendar year, starting January 1, 2017. The fee for service Medicare income of most physicians would be adjusted up or down 4% in 2019, depending on their scores. The at-risk portion of their Medicare reimbursement would rise to plus or minus 9% by 2022. The new CMS policy gives physicians more flexibility to adjust to this new reimbursement approach.

In the first option, physicians who submit at least some data to CMS’ new Quality Payment Program in 2017 will not be financially penalized in 2019. In option two, doctors can start submitting the full range of data required by CMS anytime in 2017 and qualify for a partial bonus if they do well. In option three, practices can submit data for the full calendar year and qualify for full bonuses, again assuming that they do better than average on the measures.

These three options are designed for physicians who elect to go into the Merit-Based Incentive Payments. The fourth option is to apply for recognition as one of MACRA’s Alternative Payment Models (APMs), which include certain accountable care organizations (ACOs) and the 5,000 practices that will participate in CMS’ new Comprehensive Primary Care Plus demonstration

Physicians who don’t participate in the Quality Payment Program will automatically get the full downward adjustments in their reimbursement rate in 2019. Nevertheless, some doctors might be inclined to take the hit on their Medicare income, at least temporarily, rather than invest in new electronic health records (EHRs) or upgrades or hire additional staff to meet the MIPS criteria.More info shared by steven lash.