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.