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MACRA – What Does It Mean and What Is the Impact?

With the New Year upon us, there will be continued conversation about the Medicare Access and CHIP Reauthorization Act (MACRA) program, which began in 2015 and will continue beyond 2021. MACRA is a Quality Payment Program (QPP) which replaces the current Sustainable Growth Rate (SGR) methodology and will streamline multiple current programs and reporting. This new framework will offer providers the opportunity to focus on quality health care rather than simply more care. The MACRA QPP includes the Merit-based Incentive Payment System (MIPS) and the Advanced Alternate Payment Models (APMs), both of which have different requirements.

Merit-based Incentive Payment System (MIPS)

MIPS streamlines the existing Medicare Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-based Modifier (VBM) programs into four new performance categories on which provider quality will be measured. The four categories contribute to an annual score, up to 100 points, for clinician performance. The four performance categories and associated relative weights for CY2017 is indicated below:

  • Quality (60%)
  • Advancing Care Information (previously MU) (25%)
  • Clinical Practice Improvement Activities (15%)
  • Resource Use (0% – will be weighted for 2018 and beyond)

The final score for a provider determines MIPS payment adjustments in the following calendar year. Each provider’s annual final score is publicly available from CMS.

The Quality performance category basically adopts the quality measures and reporting methods from the PQRS and VBM programs with some changes to the PQRS reporting methods. Most providers must report up to six PQRS measures, from any combinations of domains, including one outcome measure. Groups with 16 or more providers will also have a population measure calculation included.

The Advancing Care Information performance category changes Meaningful Use to a continuous scoring system where MU rates are compared to established benchmarks. In the Clinical Practice Improvement Activities performance category, providers need to either earn 20 points or 40 points, depending on size and location of the practice. Earning points includes the following:

  • Report of any combination of medium-weight (10 points) and/or high weight activities (20 points), or
  • The provider earns 40 points for participation in certain APMs, or
  • If the provider participates in another APM, they automatically earn half credit and may report additional activities to increase the score.

Finally, the Resource Use performance category, currently set to zero in CY2017, will increase to 10% in CY 2018. There are no separate reporting requirements for this particular category, as the measures are calculated based on claims data collected by CMS.