In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), repealing the flawed sustainable growth rate (SGR) payment system that had governed how physicians and other clinicians were paid under Part B of the Medicare program. The proposed rule to implement MACRA was issued by CMS on April 27, 2016. You can also read the bill text here.
MACRA replaced the SGR and its fee-for-service (FFS) reimbursement model with two paths: The Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). The Merit-Based Incentive Payment System combines the requirements of the Physician Quality Reporting System (PQRS), the Value-Based Modifier Program (VBMP), and the Medicare Electronic Health Record Incentive Program into a single reporting program. It also promotes ongoing improvement and innovation to clinical activities. Clinicians who participate to a sufficient extent in advanced Alternative Payment Models would be exempt from MIPS payment adjustments and would qualify to receive a 5 percent lump-sum bonus on Medicare payments for 2019 through 2024. Examples of APMs so far from the Center for Medicare and Medicaid Innovation (CMMI) include accountable care organizations (ACO), patient-centered medical homes, bundled payment models and other initiatives yet to be finalized.
The Centers for Medicare and Medicaid Services (CMS) will begin measuring performance for eligible clinicians in 2017, with payments based on those results beginning in 2019.
All physicians need to know which payment track they will be participating in and how their Medicare payments will be affected.Initially, most physicians are expected to be participants in MIPS. Practices that aren’t currently utilizing certified EHR technology should consider doing so. Successful reporting on many of the performance measures for both APMs and MIPs will require increasing the use of CEHRT over time.
Click here for MACRA resources and tools available from the California Medical Association (CMA), the American Medical Association (AMA) and the Centers for Medicare and Medicaid Services (CMS), inlcuding checklists, fact sheets, webinars, podcasts, news updates, and more.