On October 14, 2016, CMS released the final rule for one of the most bipartisan and significant legislative changes to Medicare in a generation, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system called the Quality Payment Program (QPP). The QPP consists of two major tracks:
  • The Merit-based Incentive Payment System (MIPS)
  •  Advanced Alternative Payment Models (Advanced APMs)

The Quality Payment Program combines the existing Medicare Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) programs into MIPS, starting with the 2017 performance year. MIPS payment adjustments are applied to Medicare Part B payments two years after the performance year, with 2019 being the payment adjustment year for the 2017 performance year.

MIPS defines four categories of eligible clinician performance, contributing to an annual MIPS final score of up to 100 points (relative weights are indicated for the 2017 performance year and associated 2019 payment year):
  • Quality (60% for 2017)
  • Advancing Care Information (ACI, renamed from Meaningful Use) (25% for 2017)
  • Improvement Activities (IA) (15% for 2017)
  • Cost (0% for 2017, but will be weighted in the future)

The final score earned by a clinician for a given performance year then determines MIPS payment adjustments in the second calendar year after the performance year. Each clinician’s annual final score will be released to the public by CMS.

Although MIPS inherits much from the MU, PQRS, and VBM programs, historical high performance or penalty avoidance under the existing programs does not guarantee the same under MIPS.

Speak with one of our consultants and get a better understanding of what MACRA means to you and how you can implement patient-centered care concepts that are right for your practice.  Call us today.