The Medicare Access and CHIP Reauthorization Act (MACRA)
MACRA: The Basics
The Medicare Access and CHIP Reauthorization Act (MACRA) is a law that significantly changed how the federal government pays physicians. Passage of the law permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models. Under MACRA, Medicare and other payers are increasingly paying physicians based on the value rather than the volume of their services.
MACRAnyms
Confused by all the MACRA acronyms? Get a roundup of all the programs, organizations, and terms related to MACRA.
Learn the MACRA acronyms»
Quality Payment Program: Your Two Payment Tracks
MIPS and AAPMs are collectively referred to as the Quality Payment Program (QPP). Physicians will choose between two Medicare payment tracks: the Merit-based Incentive Payment System (MIPS) track or the Advanced Alternative Payment Model (AAPM) track. The infographic below provides an overview of the differences between these two paths. According to the rule, performance in 2020 will determine payment adjustments in 2022.
All about MIPS
MIPS adjusts payment based on performance in four performance categories—quality, cost, promoting interoperability, and improvement activities.
All about AAPMs
AAPMs offer incentives to provide high-quality, cost-effective care. There are currently six AAPMs for primary care.
MACRA for Employed Physicians
Unless you are participating in an AAPM, family physicians in the employed setting will need to report under MIPS. Reporting at any level in 2017 will avoid a negative payment adjustment in 2019
Employed physicians need to understand the MIPS reporting requirements for several reasons:
- Final scores are attached to individual national provider identifiers (NPIs), even for those reporting as a group. Should a physician change practices between the performance period and payment year, any payment adjustments would follow them to their new practice.
- Performance in MIPS could affect salary and compensation contracts. Since performance can result in either positive or negative payment adjustments, physicians should be prepared to see this reflected in employment contracts. A strong performance in MIPS should lead to higher salary/compensation for the physician.
- Physicians should also take into consideration the MIPS scores of practices they are considering joining.
MIPS Participation Options
Will the eligible clinicians in your practice report as a group or as individuals?
Download the Making Sense of MACRA: A Guide for the Employed Physician Supplement»
Questions to Ask Your Employer About MIPS
Know your practice's QPP reporting strategy and how your performance will be measured.
Download the Making Sense of MACRA: Questions to Ask Your Employer»
Steps You Can Take Now to Realize Payment
Provide Medicare wellness and care coordination services to optimize fee-for-service revenue, improve quality, and decrease total cost of care. Services include:
- Annual Wellness Visits (AWV) -- Implement AWV to optimize revenue and improve Medicare quality and cost with minimal impact to your practice.
- Chronic Care Management (CCM) -- You and your team invest in caring for patients with chronic conditions. Get paid for it with CCM while also preparing for MACRA--without adding extra work.
- Transitional Care Management (TCM) -- Get paid for the time you invest in coordinating your patients' transition.
- Advance Care Planning (ACP) -- Guide your patients through end-of-life decisions and learn how to get paid for it.