Pete Celano, 24 August 2016math


On April 27, 2016, CMS announced a BIG potential change to Medicare:  It’s the “doc fix” bill or MACRA, which would repeal the current reimbursement formula and replace it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two parts–

  • The Merit-based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (Advanced APMs).

Most Medicare Part B clinicians will be subject to MIPS.

MIPS Financial Calculator

SA Ignite developed a very useful, free MIPS financial calculator — using a few inputs about your healthcare system, the calculator reveals the maximum possible incentives, including base and exceptional performance.

The AHA has extolled MACRA’s streamlining of the physician reporting burden, but has noted that the federal government is providing exactly zero financial incentives for upfront investments in technology to address the demands of implementation.

The estimated investment is big– $11.6 million for a small accountable care organization and $26.1 million for a medium ACO, per the AHA.

PUNCHLINE:  MACRA, or some version thereof, is inevitable.  Organizations with Data Liquidity– a facile ability to slice & dice data to know statistically significant measure values per clinician in the Quality, Resource Use & Advancing Care Information categories will survive and prosper.  The others?  Not so much.


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