Friday, October 14, 2016

CMS Issues Final Rule on MACRA; APA Is Here to Help Members Know Their Options

The Centers for Medicare and Medicaid Services (CMS) today issued its final rule implementing payment reforms—including the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions—in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

MACRA, which replaces the flawed Sustainable Growth Rate (SGR), establishes new quality reporting programs aimed at encouraging value-based care.

APA staff will be analyzing the final rule and its implications for APA members. Right now, psychiatrists should be aware of the following:
  • Psychiatrists with up to $30,000 in Medicare billings or 100 Medicare patients will be exempt from quality reporting and payment adjustments under the MIPS program.
  • Psychiatrists can ease into MIPS reporting in 2017 due to relaxed “Pick Your Pace” reporting for that year. Reporting just one measure for Quality, one Clinical Practice Improvement Activity, or all measures for electronic health record (EHR) use will avoid 2019 penalties. Reporting complete MIPS data for part (or all) of 2017 can earn modest (or slightly higher) bonuses in 2019.
  • Psychiatrists who do MIPS reporting for 2017 will not be penalized for seeing sicker, lower income patients. Their Medicare patients’ resource use will not be counted in their MIPS score.
  • Psychiatrists will only have to report four medium-weight or two high-weight Clinical Practice Improvement Activities and only five Advancing Care Information measures (for EHR use) to get credit in those categories—a significant drop from the proposed rule. 
Importantly, APA staff want to help educate members about their options. For that reason, staff are in the process of developing a variety of tools, including a web-based toolkit and webinar series among others, to make this transition as easy as possible. Psychiatric News and other APA communications will alert members as new items become available.

The downloadable APA MACRA Toolkit may include resources such as:
  • MACRA 101 Primer
  • Decision tree to help psychiatrists choose their payment pathway   
  • Checklist and timelines to get ready for MIPS
  • Additional APA and other resources to help members prepare
APA will also be launching a webinar series to walk members through the nuts and bolts of these Medicare changes, show them how they can be successful quality reporters, and demonstrate how to use the data to inform clinical practice. The webinar series can be viewed live and will be available later On-Demand on the APA Learning Center. The tentative schedule for webinars is as follows:

  • Quality 101 Reporting—This will be available in late October
  • Final Rule Overview—November 16, 2016
  • MIPS Quality Category—November 30, 2016
  • MIPS Advancing Care Information Category—December 7, 2016
  • MIPS Clinical Practice Improvement Activities Category—December 14, 2016
  • Alternative Payment Models—January 18, 2017
“The Medicare payment reforms in MACRA are upon us, including significant changes, and members may feel understandably apprehensive," said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “That’s why APA exists—to help its members. Our expert staff are here to guide members in navigating these reforms and making this transition as smooth and simple as possible. I urge you to go to our website at and see the resources we have created for you.”

For more information, see upcoming issues of Psychiatric News and the series of Psychiatric News articles on MACRA and value-based care.


The content of Psychiatric News does not necessarily reflect the views of APA or the editors. Unless so stated, neither Psychiatric News nor APA guarantees, warrants, or endorses information or advertising in this newspaper. Clinical opinions are not peer reviewed and thus should be independently verified.