MACRA/MIPS Resource Center



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


Advanced Alternate Payment Models
[Specific types of ACOs]

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


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.


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: