Healthcare is still buzzing about CMS’s Medicare physician two-track payment system, MACRA. The Merit-Based Incentive Payment System (MIPS) is a complex pay-for-performance system based on traditional fee-for-service (FFS). The other option, participation in an Advanced APM, is in reality not currently an option for the majority of providers.

The main issue providers are currently facing with MACRA is that, although there is considerable flexibility for 2017, when full implementation arrives, MIPS will make FFS untenable at a much faster pace than the development and implementation of viable APMs. So, unless something changes, a large number of clinicians will be pushed out of FFS and over the proverbial cliff before they have a safe place to land.

What is being done to address the problem?

One solution is to make MIPS less burdensome. Even though MACRA streamlines three previously separate reporting requirements into MIPS, physicians and their staff currently spend on average, 785.2 hours tracking and reporting quality measures. This adds up to over 40K annually.

The second solution is to accelerate the development of viable APM’s. Under the current rule, physicians are subject to participating in MIPS or an Advanced APM, which requires them to substantially change their delivery of care. This also requires a greater financial risk.

As implementation proceeds, substantial changes are necessary to achieve meaningful payment reform and avoid presenting physicians and other providers with an unsubstantiated choice: Remain in FFS, subject to an increasingly burdensome MIPS, or participate in a limited number of government-approved APMs, even if they are professionally and financially unrewarding.

Changes to MACRA are still in the hands of our policy makers. Stay tuned for more updates regarding MACRA implementation and the effects of the ruling on hospitals and health systems everywhere.