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 Passage of the law permanently repealed the flawed sustainable growth rate (SGR) and set up the two-track Quality Payment Program (QPP) that emphasizes value-based payment models.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.
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.
MIPS adjusts payment based on performance in four performance categories—quality, cost, promoting interoperability, and improvement activities.
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:
Will the eligible clinicians in your practice report as a group or as individuals?
Provide Medicare wellness and care coordination services to optimize fee-for-service revenue, improve quality, and decrease total cost of care. Services include: