MACRA/MIPS Resource Center



The government has introduced a 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.

Two 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 past 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 through 2018)
  • Clinicians can report as individuals or as a group

Providers are evaluated in 4 performance categories, weighted as follows in 2018

  • Quality (50%) – Replaces PQRS and the quality component of the Value-Based Payment Modifier.
  • Advancing Care Information (25%) – Recently renamed “Promoting Interoperability”, replaces MU. Uses MU measures; removes all-or-nothing approach; eliminates thresholds beyond meeting select “base” measures one time each; 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%) – Replaces the cost component of the Value-Based Payment Modifier. Calculated by CMS with no additional action required of providers.
  • Improvement Activities (15%) – New category. Providers select activities of interest from a list of 100+ possibilities.

Options: CEHRT and ACI Measure Sets

  • Providers must use a certified EHR (CEHRT) to report the MIPS ACI measures. In 2018, either 2014-edition CEHRT or 2015-edition CEHRT is acceptable. This choice determines the available ACI measure sets.



Potential Payment Adjustments:

  • Clinician’s or group’s performance is compared to a national benchmark set annually by CMS. Clinicians whose MIPS score is above the threshold may receive a positive payment adjustment to their Medicare Part B claims in proportion to their score; those with scores below the threshold receive a negative payment adjustment.


Source:  CMS and SRS Health


*Note: In the interest of facilitating clinician success, CMS has set the performance threshold at a very low level in the initial “transition years” of MIPS. Due to the program’s budget neutrality requirement, a scaling factor of less than 1 will likely apply, reducing the size of potential upward adjustments.

Additional Resources for Information: