Paper or plastic? Debit or credit? Netflix or Amazon? These are the kind of choices we are asked to make everyday. They are not, though, the type of decisions that keep us up at night.
But it’s a different story for the MIPS-or-APM pick that doctors are facing. Many doctors are currently feeling some anxiety over the looming decision they’ll have to make regarding those two reimbursement models under the Medicare Access and CHIP Reauthorization Act (MACRA). Beginning in 2019, because of MACRA, physicians accepting Medicare Part B will be required to participate either in the Merit-Based Incentive Payment System (MIPS) or an alternative payment model (APM).
While 2019 seems far off, physicians are encouraged to become familiar with both payment models now so they may make an informed decision later.
There is no one-size-fits-all process for determining which reimbursement path is best for your practice. There’s also no reason why you have to bear the brunt of this big financial decision yourself. Speak with your staff members to get their input on which model they think will work best for your organization.
MACRA applies to individual eligible professionals (EPs), groups of EPs, and even virtual groups. The first phase of MACRA (2019 and 2020) will include a broad set of MIPS-eligible clinicians, including physician assistants, nurse practitioners, and clinical nurse specialists. Come 2021 and beyond, the HHS secretary can—and most likely will—expand the list of EPs.
It’s important to note that not all providers are subject to MACRA. Hospitals and facilities are not affected. And MACRA does not apply to clinicians participating in their first year of Medicare and those with so few Part B beneficiaries as patients that they fall below volume threshold.
If you are currently participating in any reimbursement programs, they may have a significant impact on the decision you make. For instance, if you already participate in Meaningful Use, the Physician Quality Reporting System, or the Value-based Modifier, your transition into MIPS will most likely put you ahead of the game because you will be scored against other EPs and reimbursed based on your performance in these three programs. Similarly, if you are currently participating in an ACO or patient-centered medical home, you are already well on your way to APM success. By taking advantage of the programs you are already participating in, you can reduce the learning curves associated with MACRA and maximize your reimbursements.
MIPS vs APM? Each program has its pros and cons. Which one is most advantageous will depend on the particular circumstances, capabilities, and past experiences of clinician or medical practice. It is a tougher choice than paper vs. plastic but if doctors ask themselves the right questions and weigh their options, they should be able to make the right choice.