A Dozen Facts about MACRA

The Medicare SGR was axed in 2015 much to the pleasure of physicians and healthcare administrators around the cou****ntry.

We are now getting a picture of how the replacement payment plan set forth in The Medicare Access and CHIP Reauthorization Act (MACRA) law will work.

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Here are 12 facts to get you up to speed:

1. MACRA reimbursement plans apply only to practice physicians and Medicare

2. Reimbursement under MACRA starts in 2019 using data collected by CMS in 2017

3. From 2016 to 2019, reimbursements are scheduled to increase under the MPFS by .05% per year

4. There are two ways to participate:

   Merit-Based Incentive Payment System (MIPS) combines Value-based Payment Modifier (VM), Physician Quality Report System (PQRS) and Meaningful Use (MU)

   Advanced Alternative Payment Model (APM)

5. Program year 1 will see most physicians participating in MIPS

6. Providers can change between the MIPS and APM programs annually as it best applies to their practice

7. MIPS is budget-neutral, higher reimbursements are balanced out reduced reimbursements to low-scoring practices

8. Physicians with high performance scores can see 4% rate increases in 2019, progressing to as much as 9% in 2022

9. MIPS will be scored in 4 categories:

   Quality

   Cost-of-care/Resource Use

   Clinical Practice Improvement Activities

   Advanced Care Information (formerly Meaningful Use)

10. APM physicians from 2019 through 2024, will receive a lump sum payment of 5% of their prior year Medicare Part B payment

11. APMs are payment models such as Accountable Care Organizations (ACOs) and Patient-Centered Medical Homes (PCMHs)

12. CMS will update the list of qualified APMs annually