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    Nine things healthcare executives should know about MACRA


    Although CMS released the final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in October, there is still quite a bit of confusion. In fact, nearly half of U.S. physicians are not even familiar with MACRA, per Deloitte’s recent survey of 600 doctors. What’s more, nearly eight in 10 physicians said they prefer fee-for-service over the types of risk-bearing, value-based arrangements under MACRA.

    Yet, MACRA is here to stay. The final rule proposes changes that will have a major impact on providers and propel the healthcare industry toward a better future with value-based payment models.

    Here are nine things to know about the final rule:

    1. Participants can choose one of two program tracks. CMS created the Advanced Alternative Payment Models (APM) and Merit-Based Incentive Payment System (MIPS), which are the two tracks with related requirements within the Quality Payment Program (QPP), intended to increase focus on patient-centered care. The payment system’s patient engagement strategies will not only drive providers to attain the high scores needed to receive incentives, but also create a more predictable Medicare payment schedule.

    2. MIPS combines three established payment programs. To reduce the burden of participation, three programs have been merged under MIPS. This ensures single submission for all providers and requires providers to report separately for each program. The incentive programs presently under Medicare Part B are:

    • Physician Quality Reporting System (PQRS)
    • Physician Value-based Payment Modifier (VM)

    • Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs)

    3. The APMs track provides additional incentives to participations. The APMs payment track enables providers to earn added incentive payments by providing high-quality, cost-efficient care for specific clinical conditions, care episodes or populations. A qualified APM is any one of the following:

    • A Medicare Shared Savings Program Accountable Care Organization

    • A model expanded under the Center for Medicare & Medicaid Innovation (CMMI), which is not a Health Care Innovation Award recipient

    • Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration Program

    • A demonstration program required by federal law

    4. MACRA affects all providers beginning in 2017, including those with small and solo practices. It also affects healthcare IT vendors, such as data submission vendors, registries, EHRs, etc. The program will take effect over several years, beginning in 2017.

    The QPP phased timeline:

    Next: Five more things to know


    Pranjali Joshi
    Pranjali Joshi is product manager, CitiusTech.


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