RSNA: Ready or not, here comes MACRA

The 2,400-page Medicare Access and CHIP Reauthorization Act of 2015—“MACRA”—was only just finalized on October 14. But the law didn’t catch the American College of Radiology off guard.

Nor should it have: It may not directly affect payments until 2019, but its performance-review period starts just over a month from now, on Jan. 1, 2017.

Ezequiel “Zeke” Silva III, MD, of South Texas Radiology Group in San Antonio, chair of ACR’s commission on economics, underscored these facts in a Monday morning session at the 102nd annual meeting of the Radiological Society of North America in Chicago.

“To the ACR’s credit, we saw change coming. We saw a change in the climate that affected not just payment policy but policy as affected under the quality and safety domain,” Silva said. “We’ve been developing measures, metrics, appropriate use criteria, informatics tools and registries. It’s really a remarkable place for us to find ourselves.”

Silva pointed out that MACRA is rightly understood as a “quality payment program,” or QPP.

“I’m sensitive to [overuse of] acronyms, but I just want to make sure that we’re all speaking the proper terms,” he said.

MACRA’s two main pathways are in many ways parallel but in some ways complementary, he noted, referring to the Merit-Based Incentive Payment System (MIPS) and alternative payment models, or APMs.

The four performance categories under MIPS are:

• Quality—representing 60 percent of performance scoring for 2017;
• Advancing Care Information (ACI, renamed from Meaningful Use)—25 percent for 2017;
• Clinical Practice Improvement Activities (CPIA)—15 percent for 2017; and
• Cost (formerly resource use)—0 percent for 2017, but will be weighted for 2018 and beyond.

There is a differentiation in the regulations between patient-facing physicians and non-patient-facing physicians, Silva said.  

“The premise is that, if we were going to create a single system with a single scoring scale to apply to all physicians, then by definition CMS had to enable all physicians to participate,” he explained. “So when we talk about non-patient-facing physicians, all of us [diagnostic radiologists] are excluded in the first year from cost.”

The non-patient-facers are also exempt from advancing care information.

However, on Jan. 1, 2019, every physician in the U.S. will be able to log on to the federal Physician Compare website and see either his or her individual scores or, if reporting as a group, the group's scores.  

And that goes for any member of the public, any patient, any hospital administrator or even any family member.

“So the question we [diagnostic radiologists] ask ourselves today is: What are our goals? What are our aspirations? Not just as individuals, not just as a group, but as a specialty,” Silva said. “Where do we want to position ourselves on this scale?”

Radiologists who land right at the performance threshold will receive a neutral adjustment—neither a positive nor a negative.

Those who are on the maximum negative side will see a maximum negative adjustment of around 4 percent.

“But the bonus on the flip side could be 4 percent in year one and as high as 9 percent by the time of full implementation in 2021,” Silva said. “Add the bonus for exceptional performers, and some calculations yield as high as 30 to 35 percent bonus by 2021.”

“That’s a sizeable contribution for what we do.”

Indeed it is. Click here for ACR resources to help with minimizing MACRA’s risks for radiology and maximizing its rewards.