MACRA Update


In late April, CMS issued almost 1000 pages in a proposed rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The first performance year begins January 1, 2017, which will affect the 2019 payment year. CMS is combining the data from programs like Meaningful Use (MU), the Physician Quality Report System (PQRS) and the Value­Based Payment Modifier (VM) into a new system called MIPS – the Merit­Based Incentive Payment System. The previous programs will not go away, but the data will instead be used in combination to evaluate clinicians on quality (50% of total score in Year 1), meaningful use of certified EHR technology (25% of total score in Year 1), clinical practice improvements (15% of total score in Year 1) and resource use / cost (10% of total score in Year 1).

In the first year, depending on the variation of MIPS scores, adjustments are calculated so that negative adjustments will be no more than 4 percent, and positive adjustments will be up to 4 percent, with additional bonuses for the highest performers.\

The timeline and payment model, illustrating the 4%­9% payment adjustment, can be seen here.

There will be another payment method under MACRA called the Alternative Payment Model (APM), which will be in effect beginning in payment year 2019. ACOs, patient­centered medical homes, and bundled payment models fall under the APM. This is an advanced payment system rewarding some clinicians with a lump­sum incentive for quality improvement and costs savings. This lump­sum payment will allow clinicians to be exempt from MIPS. However, not all clinicians who participate in an APM will be exempt from MIPS. Both these payment programs will eliminate the Sustainable Growth Rate formula.

CMS has noted that the proposed payment models will streamline and strengthen value and quality­based payments for all clinicians and give practices the flexibility to choose how they participate in the new payment system.

Comments may be submitted electronically through an e­Regulation website until June 27th.