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MACRA - What does it mean to you?

Many of you have been asking us about MACRA. Here’s some information to jump-start your understanding about what it is and what it could mean to you and your practice.

In April 2015, the U.S. Senate averted a 21.2% reduction in Medicare payments to physicians and passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The legislation permanently repealed the Sustainable Growth Rate (SGR) payment adjustment mechanism to the Medicare physician fee schedule and replaced it with a system – to be implemented in 2019 – in which physicians will elect to remain in fee-for-service subject to a new value-based regime (MIPS), or transition their practice toward risk-based models (Alternative Payment Models, or APMs).

Merit-Based Incentive Payment System (MIPS) Overview

In addition to relatively minimal annual updates, MIPS participants will receive positive or negative adjustments based on performance in four weighted categories: quality, EHR use, resource use and clinical performance. Each clinician will be scored on a scale of 0-100 against peer clinicians. Key MIPS provisions are as follows:
  • Performance in each of the four categories will determine a participant’s annual score, which will be compared against a threshold to calculate budget-neutral adjustments.
  • Performance-based risk and reward will be phased in for participants over several years, ultimately reaching (+/-) 9%; MIPS participants will receive an annual update of .25% beginning in 2026.
  • Current performance-based incentive programs – EHR Meaningful Use, Physician Quality Reporting System (PQRS) and Value-Based Modifier – will sunset by 2018 with certain measures incorporated into MIPS.
  • A two-year lag will exist between performance measurement and payments adjustments – 2019 adjustments will be based on 2017 performance measurements.

Alternative Payment Model (APM) Overview


The APM track offers physicians stronger financial incentives, with higher annual updates and several-year guaranteed bonuses for eligible participants. Key APM provisions are as follows:
  • APM participants receive a 5% lump-sum bonus payment from 2019-2024 and receive a .75% annual update beginning in 2026.
  • To qualify for the APM track, physicians must meet a minimum threshold of payments through eligible Medicare APMs, which increases over time from 25 to 75 percent. Beginning in 2021, physicians can also qualify by meeting all-payor APM payment thresholds. 
  • APMs are largely required to meet several qualification criteria, including EHR use, measurement of quality comparable to MIPS, and bearing of “more than nominal” financial risk. Eligible APMs include ACOs with two-sided risk, bundled payment models and patient-centered medical homes.
  • APM participants are excluded form MIPS payment adjustments.


Earlier this week, CMS released the proposed rule – a 962-page document that provides even more detail on the two tracks.

If you want a shorter read, take a look at The Advisory Board’s ten early takeaways regarding the proposed rule. Watch this newsletter for more updates and analysis on what MACRA means to LHP and community providers.

(Source for this article: The Academy Advisors)

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