Payment Reform

AAFP Launches MACRA Ready Campaign

The MACRA Ready campaign, announced by AAFP President Wanda Filer, MD, MBA, FAAFP aims to help family physicians prepare for the coming changes. The links below include a host of valuable resources for you to consult.

AAFP's MACRA homepage

Making Sense of MACRA: Understanding Your Pathway

MACRA Ready250

MACRA intro webinars

FAQ on MACRA and Medicare Payment Reform

MACRA acronyms list

MACRA payments: APM vs. MIPS

MACRA Readiness: Prepare for MIPS

AAFP Showing Strong Support for DPC

AAFP's MACRA response letter

  • Despite support of the Medicare Access and CHIP Reauthorization Act, which revamps Medicare physician payment, the American Academy of Family Physicians urged the Centers for Medicare & Medicaid Services to make multiple changes to strengthen and improve proposed regulations implementing the law.

MACRA: Why it matters

On April 16, 2015, the Medicare Sustainable Growth Rate (SGR) was repealed by the Medicare Access and CHIP Reauthorization Act (MACRA) and physicians no longer face the threat of a steep 21% cut in Medicare reimbursements. MACRA also ushers in a new era of Medicare payments that will affect all family physicians. 

MACRA will incerase Medicare physician payments by 0.5% per year through 2019. Starting in 2019, all Medicare physician payments will be tied to one of two tracks. The first will be the Merit-Based Incentive Payment System (MIPS), a system that will reward physicians with bonus payments or punish them will stiff penalties based on quality measures, cost of care, meaningful use of EHRs and clinical practice improvement activities.

The second track is called Alternative Payment Model (APM). Large medical groups that can form ACOs will likely choose this track. 84% of Wisconsin family physicians are employed in large group practices (of 50 or more physicians) so we suspect that most Wisconsin FP's will end up being paid through an APM.

Already, the Center for Medicare and Medicaid Innovation (CMMI) has been testing new alternative payment models throughout the country. Two large initiatives, the Medicare Shared Savings Program and the Comprehensive Primary Care Initiative have already shown cost savings and quality improvements in their first year of operation. Private health insurers are quickly following Medicare's lead by encouraging medical groups to sign value-based contracts. 

Value-based medical care is here to stay. It will be important for family physicians to step up and become leaders as their medical groups move from a health care system that financially rewarded high volume care to one that rewards value. Family physicians will need to step out of their comfort zone. Team-based care will become the norm in primary care. Family physicians will lead teams with a focus on high cost patients who suffer from multiple medical problems. The health of the public will also be of greater improtance and FPs are well positioned to organize community groups who seek to improve health. Perhaps more than any other specialty, we will need to embrace new ways of interacting with patients through the phone, email, patient portals and utilizing team members to educate, motivate and coach patients. 

If family physicians don't step up as leaders in our large medical organizations, we will be left being told by administrators how we should practice in the new value-based system. FPs already provide value-based care. Although it has been under-appreciated in some medical groups, Medicare alternative payment models make it clear that a strong primary care system is the key to improving value and will lead to better payment through Medicare. This is once in a lifetime transition in health care financing that favors family physicians. Don't be fearful of stepping up to help lead the change that has been legislated through MACRA.

AAFP MACRA Summary 

(click to view)

MACRA Final Rule Advocacy Chart 1 

(click to view)

MACRA Resources

Direct Primary Care handout

AAFP: Direct Primary Care

Other Resources

Texas Academy of Family Physicians' Direct Primary Care Resources

AAFP: Family Practice Management

Payment for Care Management Services

CMS: Health Care Payment Learning and Action Network

Podcasts

"WAFP Discussion on Payment Reform and MACRA" (click to listen)

"The Physicians Role In the New Payment System" (click to listen)

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