The Medicare Access and CHIP Reauthorization Act (MACRA) was established to reward physicians for the value of care provided to patients, and not the volume. Part of Health and Human Service's (HHS') push to tie 90 percent of Medicare payments to quality or value and 50 percent to alternative payment models (APMs) by the end of 2018, MACRA's first performance year begins Jan. 1, 2017, for 2019 payment adjustments.
MACRA establishes a series of scheduled physician payment increases through a Quality Payment Program offering two tracks:
Merit-based Incentives Payment System (MIPS) - Combines and replaces existing Medicare physician quality reporting measures (Physician Quality Reporting System, Medicare Electronic Health Record Incentive Program, and Value-Based Payment Modifier) with a new composite performance score. Presents lower downside risk (five percent of total revenue) and less stringent upfront investment than APMs.
Advanced Alternative Payment Models (APMs) - Requires participation in advanced APMs (e.g. Next Generation ACOs, Medicare Shared Savings Program Tracks 2 & 3, patient-centered medical homes). Necessitates considerable quality measurement experience and the ability to accept high levels of risk - 25 percent by Jan. 2017 and 75 percent in five years. Medicare projects only five to eight percent of eligible clinicians will qualify for advanced APMs in MACRA's first year.
MIPS or APMs: Which is Right for Your System?
Guidehouse's MACRA calculator was developed to help your health system predict its future under MACRA. Providers can access the easy-to-use calculator to generate a snapshot of their performance under the MIPS and APM tracks.