What MACRA means for you?

What is it?

In 2015, Congress passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  The passage of this law repealed the Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians, and replaced it with new measures that combine several existing quality reporting programs into one system that rewards physicians and other healthcare providers for quality rather than quantity of care.

What do you need to know?

  • Participation is voluntary; Medicare’s fee-for-service model remains, however, participation will be rewarded with bonuses
  • New payment models include the Alternative Payment Model (APM) track and the Merit-Based Incentive Payment System (MIPS) track, physicians can enter a track based on eligibility requirements;
  • Regardless of payment track, performance with quality measures and resource utilization will be key to achieving payment increases

The two payment tracks:

  • Merit-Based Incentive Payment System (MIPS)
    • The Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value Based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program are bundled into this payment track
    • Physicians will receive a composite score (1-100) based on performance in quality, resource use, clinical practice improvement and meaningful use of certified EHR technology
    • Composite scores will be compared to a blended score of all physicians
    • Because MIPS is budget neutral, payments will be allocated across a performance scale with “lower” performing physicians subsidizing top performers payment increases
  • Alternative Payment Model (APM)
    • The APM model is still evolving and includes a wide variety of payment models including: ACOs, bundled payments, patient centered medical homes, demonstration projects required by federal law and physician focused payment models (PFPMs)
    • An APM must require physicians and other qualified healthcare professionals to use quality measures, certified EHR technology, bear financial risk unless considered a medical home under the Center for Medicare and Medicaid Innovation (CMMI) and receive payment from a significant source of value-based incentive programs.

Key dates to remember:

  • July 2015 – December 2019: Medicare payments increase by .5% each year
  • January 2016 – Physician public reporting is integrated into “Physician Compare”
  • July 2016 – CMS will release a list of proposed MIPS quality measures
  • November 2016 – CMS will finalize criteria for physician-focused payment models
  • January 2017 – The performance baseline period for MIPS begins, quality data collected from this period will affect 2019 payments
  • January 2019: PQRS, VM and Meaningful Use programs will be rolled up into the MIPS program, until this date the programs will operate independently
  • 2020 – 2025 – Payment adjustments freeze
  • 2026 – Payment rates will increase by 0.25% for MIPS participants and 0.75% for APM participants

What can you do?

  • Reach out to physician organizations. Organizations like the American Society of Clinical Oncology (ASCO) are creating task forces and committees to evaluate payment models and develop recommendations for its members
  • Engage in comment periods and vocalize suggestions, comments and concerns for the proposed MIPS performance measures
  • Begin preparing for the 2017 performance period


In the upcoming months, Provident will be releasing ways you can begin preparing for the MIPS and APM quality measures.  A key differentiator between top and low scoring performers will be those that implement clinical and business process changes prior to the 2017 performance period.

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