1. What is MACRA New way to get paid under Medicare –Replaces broken Sustainable Growth Rate (SGR) formula Streamlines multiple quality reporting systems into MIPs (beginning in 2019): Value-based payment modifiers PQRS MU Encourages participation in eligible alternative payment models

2. What does that mean for my practice? Estimates are that most dermatologists will participate in MIPS. The following dermatologists will be exempt from MIPS: –Physicians who participate in Medicare Part B With 3 exceptions: In 1st year of Medicare Part B participation Meets low volume threshold Certain participants in ELIGIBLE Alternative Payment Models

3. Your MIPS score The score will factor in performance in 4 weighted categories: Quality Measures Resource UseClinical Practice Improvement Activities Use of Certified EHR Technology

4. Beginning in 2019, all physicians will be eligible to earn a bonus of up to 4 percent. By 2022 could be eligible for a 9 percent payment bonus. Physicians who don’t participate, or perform poorly, in MIPS will receive up to a 4 percent payment reduction, and by 2022 that payment penalty will go up to a 9 percent maximum. Payment Adjustments

5. Practice example: Average Medicare Part B Specialty Payment: –$228,000 (2013 CMS data) Minimum Reimbursement Maximum Reimbursement 2019 (+/-4%)$218,880$237,120 2026 (+/-9%)$207,480$248,520

6. What about small/solo practices? MACRA allows for $20 million to provide technical assistance to practices with 15 or fewer eligible professionals participating in an APM or MIPS. This assistance is intended to position practices to transition to APMs or to improve MIPS composite scores. Priority will be given to practices in rural areas, health professional shortage areas, and medically-underserved areas.

7. Moving to APMs The other way for participation in the incentive program, separate from MIPS, is through participation in an eligible APM. AAD/A is working on alternative payment modeling for its members to help navigate this change

8. How would I get paid under an APM? If you are an APM qualifying participant: –5 percent lump-sum bonus on your Medicare payments for 2019 through 2024. – This bonus will be in addition to the incentive paid through existing contracts with the qualified APM (e.g., MSSP), demonstration program, etc. –In 2026, you will qualify for a 0.75 percent increase in your payments each year. This applies to VERY few dermatologists – likely those who are at large academic institutions or practice groups.