The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which AOA advocated for, repeals Medicare’s flawed sustainable growth rate (SGR) payment formula and also provides for slight payment increases in the coming years. The first payment increase will be effective July 1, 2015 when ODs and other physicians will receive a 0.5 percent payment increase that will be in place through December 2015. From 2016 through 2019 Medicare physician payments will increase 0.5 percent each year. While these are not large increases, these changes are significant as ODs and other physicians will no longer face the payment uncertainty that was a yearly occurrence under the SGR formula.
While MACRA provides for slight payment increases over the next several years, to avoid any negative Medicare payment penalties, ODs must be aware of various Centers for Medicare & Medicaid Services (CMS) programs including the Physician Quality Reporting System (PQRS), the Value Based Payment Modifier (VBM) and the Electronic Health Record (EHR) Incentive Programs. Doctors who do not participate in PQRS in 2015 will receive a negative 2 percent PQRS payment decrease in 2017. Additional payment penalties will be assessed under the VBM for those physicians who do not participate in PQRS. Physicians with practices that have fewer than 10 practitioners eligible to participate in PQRS will be penalized an additional 2 percent under the VBM in 2017 for failure to participate in PQRS in 2015. Some ODs in group practices with more than 100 practitioners eligible to participate in PQRS are already feeling the negative impacts of the VBM. Penalties for large practices are being assessed this year based on performance in 2013. Large practices that did not register for group PQRS reporting in 2013 and did not report one quality measure are receiving a 1.5% PQRS payment decrease and a 1% VBM payment decrease in 2015. AOA urges ODs to take action this year to avoid value-based modifier penalties.
While ODs have participated in high numbers in the EHR Incentive Programs and have earned over 317 million dollars in incentive bonuses, ODs should be aware that participation in the program is required each year to avoid payment penalties. Lack of participation in the EHR incentive program in 2015 will result in a 3% payment decrease in 2017. Considering all of these Medicare programs together, an OD who is a solo practitioner could have their Medicare payments reduced by a total of 7 percent in 2017 if they do not participate in PQRS and the EHR incentive program in 2015. Take action now to avoid these significant penalties.
If you have questions regarding any of these programs, please contact Rodney Peele at firstname.lastname@example.org or Kara Webb at KCWebb@aoa.org.