In an extremely busy year for Medicare delivery and payment reform, regulatory implementation of the 2015 Medicare Access and CHIP Reauthorization Act (MACRA) stands out. This past April CMS published the agency's 960-page proposed rule to implement the law. The proposed rule, that will go final this fall, will change the way Medicare physician payments (Medicare Part B) are annually updated beginning in payment year 2019. Payment updates, either at the individual provider or at the group level, will be calculated either by the Merit-based Incentive Payment System (MIPS), a composite score based on four, differently weighted, component scores, or via provider participation in what CMS defines as an "advanced" Alternative Payment Model (APM) pathway, e.g., Track 2 and 3 ACOS and Patient Centered Medical Homes that meet certain financial risk criteria.
During this 22-minute discussion Ms. Mara McDermott evaluates how CMS proposes to define APM nominal risk, how the agency has defined the MIPS composite score, the effect MACRA will have on small practices, how Medicare Advantage plans and physicians can be included in MACRA, and several inter-related issues. (While the introduction to this discussion provides some brief explanatory information, our conversation assumes the listener has some familiarity with Title I of the MACRA law.)
Mara McDermott is the Vice President of CAPG (formerly the California Association of Physician Groups) where she leads the organization's federal legislative and regulatory activities in Washington, D.C. Prior to joining CAPG, Mara was Counsel in the health industry practice of Akin Gump Strauss Hauer and Field. Mara received her JD with high honors and her MPH from George Washington University School of Law in 2007. She received her BA in 2003 from the University of California, Davis.
The CMS MACRA proposed rule is at: https://www.federalregister.gov/articles/2016/05/09/2016-10032/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm
Information concerning CAPG is at: http://www.capg.org/