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important for the physician to document that
he has discussed osteoporosis than it is for him
to actually discuss it.
The physician must check the right boxes
to convey this information to third party
payers. Documentation is important but not
at the expense of patient care. When I have to
spend more time documenting my care than
delivering care (getting a history, examining
the patient, processing data, making decisions
and communicating my recommendations to
the patient), something is wrong.
I believe that the driving force in this
boils down to a complete lack of trust in
physicians by those who design payment
systems. Furthermore, physicians do not
trust the bureaucrats in the setting of these
many mandates, which are added hassles that
are not perceived to improve patient care.
Because of this lack of trust by third party
payers, physicians have to spend time proving
what they have done. I do not know how
we get around that unless you eliminate the
bureaucrats, and restore the patient-physician
relationship whereas the one-on-one patient
interaction determines if he or she trusts the

One Size Doesn't Fit All
In fairness, there are physicians who do
not take care of patients properly for various
reasons. However, I like to think these are
a minority. Unfortunately, it appears that a
majority of physicians have to jump through
hoops to "protect the public" because of the
actions of a minority.
I think the only way to solve these issues
is to find a way to remove the bureaucrats
from the equation. If that cannot be done,
there needs to be a LOT of dialogue between
practicing physicians and the bureaucrats as
to the unforeseen ramifications of these value
based systems. Practicing physicians, not
bureaucrats, must define quality and even that
leaves a lot to be desired for reasons noted
As it stands, we are headed towards a one
size fits all, cookbook style of medicine with
no room for care of individual patients. Keep
in mind that MACRA and MIPS are separate
from the Affordable Care Act (ACA), and they
will not go away if the ACA is repealed.
If all of this is okay with you, just keep
going about your business without raising a
fuss. Otherwise you need to make your voice
heard and contact the policymakers - your

Generally Speaking . . .

mon t m e d s o c .c om

MACRA and MIPS in a Nutshell
What is MACRA?

MACRA, an acronym for Medicare Access and CHIP Reauthorization Act, is a new law that
will gradually change the way physicians are paid under Medicare, aligning reimbursement
more closely to quality, outcomes, and cost. It offers significant financial incentives for
physicians to participate in risk-bearing, coordinated care models and to move away from the
traditional fee-for-service (FFS) system.

What is MIPS?

MIPS, an acronym for Merit-Based Incentive Payment System, is a new program that
will determine Medicare payment adjustments. Using a composite performance score,
eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment
adjustment. The Composite Performance Score is based on four performance categories:
quality, resource use, clinical practice improvement activities and meaningful use of certified
electronic health records (EHR) technology.

What is happening in 2017?

The MACRA final rule provides clinicians flexibility for reporting under the Quality Payment
Program (QPP) for 2017 to provide a phasing in of this new system. The 2017 performance
year will impact your Medicare payment in 2019. The size of your payment will depend on
how much data you submit and your performance results. Payment adjustments range from
-4 percent to +4 percent of your Medicare FFS revenue for this first year.

What is PAMED doing to support me in 2017?

PAMED and its subsidiary PMSCO want to support physicians in earning a positive
payment adjustment based on this performance year. This means that as a physician you will
need to report defined metrics to the Centers for Medicare and Medicaid Services (CMS).
We understand this is a big administrative burden, so PMSCO is partnering with a thirdparty organization to support you in selecting appropriate metrics and submitting them to
CMS at the appropriate time. We are currently in discussions with several potential vendors
and will have additional details on the vendor and pricing by the end of February. In the
longer-term, PMSCO's recently approved funding to create Clinically Integrated Networks
(CINs) throughout the commonwealth will support physicians in making the transition to
value-based payment models. This will provide physicians with options to eventually qualify
for Advanced Alternative Payment Models (Advanced APMs) and achieve the 5 percent
payment each year.

What should I do now?

1. Educate yourself: Much has been written on this topic, and you can learn more at PAMED published a comprehensive insert in its Pennsylvania
Physician magazine on the details of MACRA and the Quality Payment Program (QPP).
The magazine was mailed in mid-February and the insert was available to members only.
You can also find that member-only insert at
2. Understand your performance: If you have been reporting metrics to Physician
Quality Reporting System (PQRS), you should receive from CMS a Quality and
Resource Use Report (QRUR), which summarizes your performance in PQRS quality
metrics and cost of care versus national benchmarks. This is the best proxy measure
of how you may perform in MIPS. You can access your report at: https://portal.cms.
gov. If this is your first time accessing the portal, instructions for creating an account
can be found at:
3. Look for further communication from PMSCO: We will be finalizing services and
pricing with a vendor to support you in MIPS reporting by the end of February. At that
time, details will be posted on the PAMED and PMSCO websites and emailed to our
contact list.


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