This year marks the beginning of Medicare’s new Quality Payment Program. Created by the 2015 Medicare Access and CHIP Reauthorization Act (MACRA), the Quality Payment Program fundamentally changes the way Medicare pays for Part B services – continuing the shift away from fee-for-service to payment models that reward value and efficiency.
In 2017, the Quality Payment Program will affect more than 700,000 clinicians nationwide, requiring them to either:
1. Demonstrate significant participation in a CMS-designated “Advanced Alternative Payment Model,” such as the Medicare Shared Savings Program Track 2 or Track 3, or
2. Begin submitting an array of data on quality, cost, technology use and practice improvement under what’s called the “Merit-Based Incentive Payment System (MIPS).
Unfortunately, all of this is “news” to a lot of clinicians – and that’s bad news for hospitals.
Multiple surveys over the past year or so have shown a general lack of physician awareness and knowledge about MACRA. In a 2016 Deloitte Center for Health Solutions survey, 50 percent of physician respondents had never heard of it; 32 percent recognized the name but were unfamiliar with its requirements.
This is a big deal because clinicians who are eligible for the program must meet minimum participation requirements to avoid a negative payment adjustment to their Part B reimbursement rates beginning in 2019. If your facility employs clinicians who receive negative payment adjustments, it will affect your revenue. On the flip side, if your eligible clinicians participate in the program and perform well this year, they could receive payment bonuses beginning in 2019.
That’s why it’s critical that you communicate with your clinicians – especially those you employ directly – about MACRA and the Quality Payment Program.
You want your eligible clinicians (who in 2017 include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, and groups that include any of those clinicians) to understand what’s at stake for them and the hospital, and what you are doing to support their success.
Before you start the conversation, here are a few tips to consider:
By communicating effectively, you can increase awareness and adequate participation in the program so you achieve the maximum financial benefit and engender increased trust and goodwill among your clinicians.
Erin George is a Senior Account Supervisor at Lovell Communications. Connect with Erin at firstname.lastname@example.org.
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