What you need to know about ‘MACRA,’ the new Medicare pay reform law

What you need to know about ‘MACRA,’ the new Medicare pay reform law

Now that Medicare physician payment reform is in effect, optometrists need to know how it will affect future payments—and how new programs are intended to work.

As a result of AOA advocacy, doctors of optometry are recognized as physicians for major quality improvement and payment and delivery reforms.

On April 16, President Obama signed the "Medicare Access and CHIP Reauthorization Act of 2015" (MACRA) into law. Thanks to optometry's advocacy efforts, the historic legislation fully recognizes doctors of optometry as physicians for all major quality improvement and payment and delivery reforms.  

Just hours before the Senate passed the bill, more than 500 AOA doctor and student Congressional Advocacy Conference attendees were on Capitol Hill, urging their elected leaders to scrap Medicare's flawed annual update formula and help advance optometry's other top priorities.

What's in the new MACRA law?

A changing payment system
The new law repeals Medicare's sustainable growth rate (SGR) formula and creates a narrow pathway to higher Medicare payments, largely through a consolidated and expanded incentive program called the Merit-Based Incentive Payment System (MIPS). The system will comprise elements of the Physician Quality Reporting System, Value-Based Modifier and Electronic Health Records Meaningful Use.

With Medicare fee-for-service retained, physician rates will increase by 0.5 percent starting in July and each January until 2019. Through MIPS, doctors of optometry and other physicians could earn significant bonuses, based on a 100-point scale that reflects performance on quality, resource use, clinical practice improvement activities and meaningful use of certified electronic health record technology.

Starting in 2019, bonuses could reach 12 percent, and 27 percent by 2022, though some doctors might face penalties for not meeting quality targets. ODs may earn an additional five percent bonus each year by participating in an accountable care organization or other alternative payment model.

MACRA's new quality-improvement efforts also focus on the use of clinical data registries, making AOA's MORE (Measures and Outcomes Registry for Eyecare) an even more important AOA member benefit.

Ongoing advocacy
Even while supporting MACRA's final passage, the AOA was working with other physician groups to raise concerns about two misguided provisions in the legislation. Although they would not impact optometry or the delivery of eye health care through Medicare today, the provisions are based on limited physician-level participation, an approach AOA opposes in all instances as a matter of policy.

  • Care Management Lead for Complex Chronic Conditions
    Optometrists are not eligible for a new program open only to providers who oversee and coordinate all of the care needed by Medicare beneficiaries with complex chronic conditions. While this won't interfere with an OD's ability to provide care to those with chronic conditions, it does preclude the possibility of receiving a specific incentive for coordinating all of the care these patients need.

  • Resource Use Measurement Delay
    The law delays for one year (to 2019) the ability of ODs to participate in a program that assesses how to better measure physician resource use during certain episodes of care and for specific patient conditions. A delayed start under this new and separate effort does not limit full OD participation in larger pay and delivery reforms, including the calculation of "resource use" under the MIPS program, which will largely be based on the existing Value-Based Modifier.

AOA will continue to press Congress and CMS on these concerns and push for access and physician fairness as a foundation of the implementation process, and continue to analyze each individual provision of the legislation so that member doctors can access the latest and most relevant updates on the MACRA law and other coming changes to Medicare.

For more information, contact AOA Washington staffer Matt Willette, director of congressional relations.

April 23, 2015

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