Getting paid for services provided is fundamental to maintaining and growing a rheumatology practice. But getting paid in today’s healthcare environment can be anything but easy. New rules governing Medicare reimbursement under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which require practices to focus on quality, value and accountability under MACRA’s pay-for-performance program (Quality Payment Program, or QPP), are challenging the way rheumatologists and other healthcare providers get reimbursed, particularly when caring for patients with complex, chronic disease.
A session at the 2019 ACR/ARP Annual Meeting will highlight how the ACR can help rheumatologists navigate this transition from volume-based to value-based payment models. The session, Get Paid: Update on MACRA, APMs and MIPS Tips, is scheduled for 1 p.m. on Tuesday, Nov. 12.
Attendees will hear the latest updates on the two QPP payment tracks: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). In addition, members will learn about RISE, a registry created to help rheumatologists complete their CMS-required reporting under the MIPS pathway of the QPP.
“Attending this session will provide the nuts and bolts to tackle ongoing developments and where to turn for help,” says Angus Worthing, MD, FACR, FACP, chair of the ACR Government Affairs Committee (GAC).
Understanding Payment Programs
Dr. Worthing will open the session with an update on MACRA and MIPS, including first-year reimbursement bonuses and penalties in the QPP and proposed changes to MACRA. He will also discuss trends in the programs, such as increasing thresholds in MIPS adjustments to avoid cuts and receive bonus payments. For example, he says, the 2020 CMS Proposed Rule includes an estimated 15% increase in reimbursement for cognitive care of patients with complex chronic conditions, such as rheumatoid arthritis beginning in 2021, a change supported by the GAC’s advocacy efforts.
The GAC also is working to ensure that MIPS cost measures don’t penalize rheumatologists for the increasing costs of medications or the undue costs of other medical conditions treated by primary care physicians.
Kent “Kwas” Huston, MD, co-chair of the ACR’s APM working group, will follow with a discussion on APMs, including a rheumatology-specific one the working group is developing. “This has the potential to allow rheumatologists to be paid using a system that is geared for those of us in private practice,” says Christopher R. Morris, MD, a session moderator.
Guiding Success
Janell Martin, the ACR’s director of registry operations, will close the session by talking about RISE, a registry for collecting the data needed for the MIPS system. “As someone whose practice is using RISE to do the attestation, I can affirm that the people in charge of RISE are doing everything they can to help us private practitioners succeed in this era of EHR, MU and all those other initials,” says Dr. Morris.
Howard Blumstein, MD, a co-moderator of the session, calls the session “a primer and update on where we are with these programs and where we are likely heading.”
Given the importance of these programs for how rheumatologists are currently paid, Dr. Blumstein emphasizes the value of the session to “provide ways for practices to continue to survive and thrive in the current evolving healthcare environment.”
Mary Beth Nierengarten is a freelance medical journalist based in Minneapolis.
