MACRA/MIPS

MACRA/MIPS


capitol-building

The government has introduced a new set of acronyms to describe MACRA, all of which, in practice, are being used interchangeably

  • MACRA – Medicare Access and Chip Reauthorization Act: the legislation that lays out the goals for the program
  • QPP – Quality Payment Program: the structure and regulations that CMS created to implement MACRA
  • MIPS – Merit-Based Incentive Payment System: the set of requirements and scoring methodology upon which most participants will be measured—and incentivized—in the first few years of MACRA

 

MACRA accomplishes 4 goals

  • Replaces the SGR (Sustainable Growth Rate calculation that previously served as the basis for annual Medicare professional fee schedule increases) and sets predictable Medicare rates
  • Accelerates the shift to “Value-Based Payment” to reward quality over quantity of care.
  • Ends MU, PQRS, and the Value-Based Payment Modifier as separate Medicare programs with their own incentive/penalty structures.
  • Consolidates these programs into a new program, effective 2017, with financial impact beginning in 2019.

Features of the Final Rule

 

 

Issued October 14, 2016

 

To be effective January 1, 2017

 

 

2 paths to participation in MACRA

APMs:

Advanced Alternate Payment Models
[Specific types of ACOs]

  • Involve financial risk
  • 5% annual bonus + higher fee increases

MIPS:

Merit-Based Incentive Payment System

  • Reformats current programs: MU/PQRS
  • Payment adjustments based on performance

 

 

 

 

 


Although the APM option is attractive, the vast majority of providers should plan to participate in MIPS initially because only a few models qualify as Advanced APMs and because few physicians will meet the APM participation thresholds to qualify for that option.

MIPS

Eligible Clinicians (formerly known as “eligible providers or EPs”)

  • Physicians and dentists
  • PAs
  • NPs
  • CNS’s
  • CRNAs
  • (PTs/OTs not eligible in year 1 or 2)
  • Clinicians can report as individuals or as a group

Providers are evaluated in 4 performance categories, weighted as follows in 2017

  • Quality (50%, 60% in 2017) – Replaces PQRS and the quality component of the Value-Based Payment Modifier.
  • Advancing Care Information (25%) – Replaces MU. Uses MU measures; removes all-or-nothing approach; eliminates thresholds beyond meeting each measure once; emphasizes patient access to information, patient engagement, and health information exchange; allows providers to focus on areas of greatest interest/relevance to their practice.
  • Resource Use (10%, 0% in 2017) – Replaces the cost component of the Value-Based Payment Modifier. Calculated by CMS with no additional action required of providers.
  • Clinical Practice Improvement Activities (15%) – New category. Providers select activities of interest from a list of 90+ possibilities.

Potential Payment Adjustments:

  • Clinician’s or group’s performance is compared to national benchmark set by CMS
  • Impact on Medicare Part B Fee Schedule:

“Pick Your Pace” Participation Options for 2017

 

 

Additional Resources for Information: