September is almost behind us, and with its passage most of us will enjoy relief from the sometimes-oppressive summer heat. Recently, CMS Acting Administrator Andy Slavitt served up a bit of relief of his own, announcing in a blog post that CMS has heard the voice of organized medicine and plans to offer a few options for docs facing MIPS in 2017. Although the details will not appear until we see the MACRA implementation final rule later this year, today let’s explore the potential impact of Mr. Slavitt’s sneak peek.
Regular readers of this blog separate themselves from the typical provider in this country, many of whom have no clue about the looming changes MACRA has in store for them. As outlined in this blog, MACRA has created two provider paths for 2017 and beyond. The path CMS prefers is participation in Alternative Payment Models (APMs), and where possible, Advanced APMs. Docs not participating in an Advanced APM will face the Merit-based Incentive Payment System (MIPS) in 2017. MIPS effectively rolls up Meaningful Use, PQRS, and the Physician Value-Based Payment Modifier (VPM) into a single incentive program. In addition to these three familiar programs, MIPS includes a brand new and untested element known as Clinical Practice Improvement Activities (CPIA). Long story short, MACRA dictates that the 2019 fee schedule for “MIPS eligible clinicians” is dependent on how the doc’s 2017 MIPS score compares with the MIPS scores of the rest of the docs across the country.
Participating in an Advanced APM, like an ESCO, Next Gen ACO, or track 2 or 3 MSSP ACO creates the opportunity for you to avoid the tyranny of MIPS and collect a 5% bump in your fee schedule for your troubles. Believe me when I say there are a number of nuanced details under the covers, but in a nutshell, that’s what we knew prior to Mr. Slavitt’s timely blog post.
Mr. Slavitt’s blog post foreshadows what we can expect to see when the MACRA implementation final rule emerges sometime between now and November 1. I’d summarize the contents of the post as follows:
Participating in an Advanced APM remains remarkably attractive in 2017, allowing a provider to avoid MIPS and potentially collect the 5% Advanced APM incentive. But for those of you unable to participate in an Advanced APM next year, MIPS is going to be a lot less painful in 2017 than we originally thought. Mr. Slavitt basically outlined 3 paths for MIPS in 2017; if you successfully participate in one of the 3, you will not experience a MIPS penalty in 2019. Those options include:
- Sign up and take your best shot during the entire calendar year of 2017, facing the Full Metal Jacket of MIPS as written. The upside here is you have a shot at the maximum MIPS bonus in 2019, which is likely to be a 4% increase for your fee schedule.
- Elect to report MIPS for a “reduced number of days.” Although there is no mention of how many days, CMS is not in the habit of reinventing the wheel so if I were a betting man, my bet would be that “MIPS light” would mean reporting MIPS for either 90 days or a calendar quarter. Of course that’s pure speculation on my part. The blog post states that docs in this bucket “could qualify for a small positive payment adjustment.” Stay tuned for the details as you will want to understand what this carrot looks like before expending the energy necessary to chase it.
- Last but not least, is the option that appears most attractive of the 3. This one states that if you step up to the plate and send them “some data”, you will not be penalized in 2019. Again the devil is in the detail, but based on past experience this looks like the easy button. The difference between this option and doing nothing is likely to be a 4% haircut for your entire Part B book of business in 2019.
What should you do?
The fact that we have this sneak peek is a signal that likely represents the overwhelming pressure the agency has incurred since releasing the MACRA proposed rule 6 months ago. And while it’s tough to hand out advice based on a blog post, were I a practicing nephrologist with no opportunity to participate in an Advanced APM next year, this sneak peek would allow me to sleep better at night. At the end of the day, with this post the “tyranny” of MIPS has been postponed until at least 2018.
Option 1 above is the MIPS we anticipated prior to Mr. Slavitt’s blog post. It’s expected to be a lot of work, but it is the only way you will be eligible for the maximum MIPS incentive. My bet is that maximum is going to be capped at 4%. As you may recall, this is budget neutral program. The accelerators built into the original program (the published possible maximum of a 12% bump in 2019) were very much dependent on the amount of money collected from those whom MIPS penalized. The only folks penalized in the new world are the docs who stick their heads in the sand and don’t participate in the program at all. I suspect the number of non-participants will now be small in light of option 3 above.
Granted, I’d prefer to see the final rule before making predictions, but reading the tea leaves makes me believe the vast majority of nephrologists living outside an Advanced APM may simply report a very limited set of data in 2017, avoid the 2019 penalty, and gear up for a full run at MIPS in 2018. Given the fact that the EHR industry is pedaling as fast as it can to get ready for MACRA and the next round of whatever we are now calling Meaningful Use, this is indeed welcome relief from the summer heat.
What are your thoughts about Mr. Slavitt’s post and the new MIPS options? Send us a comment and join the conversation.
Terry Ketchersid, MD, MBA, practiced nephrology for 15 years before spending the past seven years at Acumen focused on the Health IT needs of nephrologists. He currently holds the position of Chief Medical Officer for the Integrated Care Group at Fresenius Medical Care North America where he leverages his passion for Health IT to problem solve the coordination of care for the complex patient population served by the enterprise.