Expect new quality pay plan(s).
You won’t ever have to cross your fingers again in hopes that Medicare doesn’t suddenly slash your pay under the Sustainable Growth Rate (SGR) formula.
That’s because Congress finally acted to eliminate SGR in favor of a different way to calculate Medicare pay. The change comes none too soon — you faced a 21 percent pay cut slated for April 1, and that followed 17 Congressional payment “patches” since 2002 to halt the payment nosedive.
“No more will we be kicking the can down the road with another temporary ‘fix’ to the SGR rate,” said U.S. Sen. Ben Cardin (D-Md.), a member of the Senate Finance Subcommittee on Health Care, in a statement.
Read on to see how the law, known as the Medicare Access and CHIP Reauthorization Act (MACRA), will impact your pay in the near- and long-term.
Expect Pay Initial Pay Boost, New Model
For now, you’ll receive Medicare payment at the same rate you’ve been getting since Jan. 1. But as of July 1, you can expect to see the first of several 0.5 percent increases.
MACRA gives 0.5 percent annual boosts to Medicare pay for five years through 2019, after which practitioners will get bonuses based on quality of care rather than the number of procedures they administer.
Here’s how it works: The bill calls for consolidating three current incentive programs — Physician Quality Reporting System (PQRS), Electronic Health Records (EHR) meaningful use, and the value-based modifier program — into a new Merit-Based Incentive Payment System (MIPS). The new MIPS will encourage other payment models, such as accountable care organizations (ACOs), to incentivize quality medical care.
“Starting in 2026, we would see two conversion factors, one that applies to providers that participate in advanced payment models such as an ACO, with a 0.75 percent annual update. A second conversion factor with a 0.25 percent yearly increase would apply to providers who do not participate in advance payment models,” explains Michael A Granovsky MD, FACEP, CPC, president of LogixHealth, a national coding and billing company.
“Passage of this historic legislation finally brings an end to an era of uncertainty for Medicare beneficiaries and their physicians — facilitating the implementation of innovative care models that will improve care quality and lower costs,” said James L. Madara, MD, AMA executive vice president and CEO, in a statement.
Prepare for Other Changes
Unlike last years’ SGR legislation, Congress did not add a delay to ICD-10 implementation. Last years’ postponement was the third delay in six years, and industry experts were concerned that Congress would delay the code set again this year.
Be ready: There are no further ICD-10 delay stipulations in the legislation this year, which means your dermatology practice needs to be ready for the Oct. 1 implementation deadline.
MACRA contains other provisions that could impact your practice, such as the following: