Making Sense of MACRA: Understanding Your Pathway


Physicians will participate in one of two payment pathways when the MACRA performance period begins in 2017.

Fam Pract Manag. 2016 Nov-Dec;23(6):33-36.

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An Alternative Payment Model (APM) is one of two new payment tracks established by MACRA. It involves a new approach to paying for medical care through Medicare that incentivizes quality and value. As defined by the law, APMs include: the Centers for Medicare & Medicaid Services’ (CMS) Innovation Center Model, Medicare Shared Savings Program (MSSP), a demonstration under the Health Care Quality Demonstration Program, or a demonstration required by federal law.

The Merit-Based Incentive Payment System (MIPS) is another new payment track established by MACRA that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-Based Payment Modifier), and the Medicare Electronic Health Record (EHR) Incentive Program. MIPS consolidates these Medicare initiatives into a single program based on: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology.


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Making Sense of MACRA: Options for Meeting the 2018 MIPS Requirements

To avoid a negative payment adjustment from Medicare in 2020, practices must achieve a MIPS final score of at least 15 points for the 2018 performance period. Here's how to meet this performance threshold.