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    MACRA changes are part of volume-to-value shift

    Clinicians need to understand system basics, reporting requirements; consider new models


    Reminding physicians how much is at stake through MIPS incentives, Dr. Parke noted that the maximum adjustment factor for 2019 is ±4% based on 2017 performance, rising to ±9% in 2022 based on 2020 performance. Additional adjustments up to 10% are possible based on exceptional performance from 2019 to 2024, but “don’t count on it” was Dr. Parke’s assessment of that prospect.

    While MACRA, MIPS, and APMs may seem simple, the reality is that the new system is extraordinarily complex and somewhat fluid. A few of the questions surrounding the system include who determines quality, are the metrics clinically relevant, and are they risk adjusted? Are costs correctly attributed? How is the data collected and by whom? There is still a lot of confusion about this program in the medical community, Dr. Parke said, adding that some physicians have not even heard of it.

    The policy goals are to correct overvalued services, and there is also an effort to reduce physician income disparity both at a social level and within the physician community by eliminating the intensity component, re-evaluating times, and providing bonuses to underpaid specialties, largely primary care.

    As to how MACRA might affect retina specialists, Dr. Parke referred to statistics for intravitreal injections in Medicare, which saw a 3500% increase over a 10-year period starting in 2005. More specifically, intravitreal injection (CPT 67028), which requires 22 minutes of physician work, is the second highest intensity payment per minute after emergency intubation. Combined Part B payments for ranibizumab and aflibercept totaled $2.5 billion in fee for service Medicare in 2015.

    “These figures make intravitreal injections and Part B drugs a continued target for payment scrutiny and demand continual advocacy activity by the Academy,” noted Dr. Parke.

    It’s worth asking whether MIPS is in danger despite the bipartisan support for MACRA when it was passed in 2015. The Medicare Payment Advisory Commission has suggested that physicians should move as much as possible to APMs such as accountable care organizations (ACOs) or medical homes. However, most of today’s ACOs do not have bimodal risk, Dr. Parke said.

    Nancy Groves
    Nancy Groves is a freelance medical writer.

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