Making Sense of MACRA, Part 2: Value-Based Payment and Your Future


Your performance this year will affect your Medicare payment in 2019.

Fam Pract Manag. 2017 Jan-Feb;24(1):12-15.

Author disclosure: no relevant financial affiliations disclosed.

The world of physician payment was turned upside-down with passage of the Medicare Access and CHIP Reauthorization Act (MACRA) in April 2015. Since then we have been learning the ins and outs of the law and emerging regulations that will transform Medicare physician payment. Additional details were released in October 2016, when the final rule was published in the Federal Register,1 so this article continues our previously published article on “Making Sense of MACRA.”2

First, a brief recap: The passage of MACRA repealed the “unsustainable” sustainable growth rate formula, which was set to cut physician Medicare payments by 21 percent in 2015. The legislation established two new tracks for payment, the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Model (APM). It created strict criteria for entry into APMs and outlined a scoring system for MIPS. The proposed rule released by the Centers for Medicare & Medicaid Services (CMS) in April 2016 gave names and definitions to the programs described in the legislation, proposed further criteria for participation in the newly named Advanced Alternative Payment Model (AAPM) track and scoring criteria for MIPS categories, and named the two tracks the Quality Payment Program (QPP).

The final rule solidified what was proposed and provided a better understanding of exactly what to expect in the future, which is coming sooner than you might think. Although you won't be paid under MIPS or the AAPM track until 2019, your performance for that payment year begins in 2017. You can choose the extent of your participation in MIPS for the first performance period through the CMS “Pick Your Pace” program, which provides the options described and depicted below:

  • “Test” the program. Ensure that your system is working and you are ready for further participation by submitting at least one measure of quality or one improvement activity or the required advancing care information (ACI) measures to CMS. With this option there is no negative payment adjustment.

  • “Partially” participate. Report more than one quality measure or more than one improvement activity or more than the required ACI measures for at least 90 days. This could earn you a small positive adjustment, and you would be exempt from a negative adjustment.

  • “Fully” participate. Report all required quality measures and improvement activities and ACI measures for at least 90 days. This could earn you a positive adjustment based on your MIPS final score, and you would be exempt from a negative adjustment.

  • Don't participate. You will receive the maximum negative payment adjustment.

  • Participate in the AAPM track if you qualify. This option will be described later in the article.


The Merit-Based Incentive Payment System (MIPS) path of the Quality Payment Program offers three participation options for 2017. The size of your payment in 2019 will depend both on how much data you submit and on your performance r

About the Author

Dr. Mullins is medical director of quality improvement for the American Academy of Family Physicians.

Author disclosure: no relevant financial affiliations disclosed.



1. Medicare program; merit-based incentive payment system (MIPS) and Alternative Payment Model (APM) incentive under the physician fee schedule, and criteria for physician-focused payment models. 81 Federal Register 77008-77831 (2016) (codified at 42 CFR 414, 495).

2. Mullins A. Medicare payment reform: making sense of MACRA. Fam Pract Manag. 2016;23(2):12–15.


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