Will you choose MIPS or APMS? Lots of MACRA acronyms for Physicians.

More CMS acronym nightmares. And, participation in MACRA is not optional! MACRA stands for "Medicare Access & Chip Reauthorization Act".  MACRA brings a payment adjustment in 2019 that can be up to 4%, and in the alternative, payments will be reduced if a provider does not participate. MIPS stands for "Merit-Based Incentive Payment Systems". MIPS combines even more acronyms into one program. MU + PQRS +VBM = MIPS. Confused yet?  APM stands for "Alternative Payment Model".  A large proportion of clinicians are anticipated to elect MIPS in the first year because qualifying for APMS can be challenging. Providers must be in a  SSP, ACO, CEC, CPC or OCM to participate in APM. If you don't know these acronyms, it is a good bet that you will choose MIPS for 2017. 

CMS estimates that 81% of physician in large groups (greater than 100 physicians) will earn a positive MIPS adjustment. In contrast, it is estimated that  87% of eligible clinicians in solo practices will receive a negative adjustment. To assist solo practitioners, there are some new proposed rules including an option that allows solo practitioners to join "virtual" groups to combine their MIPS report.  Data collecting for MIPS will be a significant burden and expense for both independent physicians and groups. Many see MACRA causing a further decrease in solo practices, consolidation of medical practices and continued group practice acquisition by hospitals.

A JAMA editorial by Robert A. Berenson, M.D. predicts that MIPS will fail to improve the quality of US healthcare because of its obsession with a few random and unreliable performance measures. This obsession will be at the expense of paying proper attention to qualitative factors such as the rate of misdiagnosis.  Other articles call MIPS a statistician's nightmare.  There are some helpful resources on the internet. If you are in Texas, you will  want to take advantage of the Texas Medical Association resources on this complex topic.  https://www.texmed.org/MACRA/