What is MACRA, and why is this important to me?
Share |

What is MACRA, and why is this important to me?

In April 2015, Congress passed the landmark bipartisan legislation MACRA (Medicare Access and CHIP Reauthorization Act).  This legislation permanently replaced the Sustainable Growth Rate formula and established two new tracks for physician payment:  the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APM).  An estimated 96% of participating providers will get paid under the MIPS track.  To qualify for the APM track, a significant amount of revenue must be received through eligible alternative payment models.  

Participation and performance in these initiatives will determine future reimbursements.

The Centers for Medicare & Medicaid Services (CMS) will base payment adjustments for both MIPS and APM based on performance periods two calendar years prior to the adjustment.  For example, performance during 2017 will influence payment adjustments in 2019. 

Under the MIPS track, providers will report measures across four categories:  quality, cost (resource use), clinical practice improvement activities (CPIA), and advancing care information (EHR use). Performance will then be aggregated into a MIPS composite performance score.  Based on the composite score, a payment adjustment will be determined and applied two calendar years later. An equal number of providers will receive upward adjustments and downward adjustments to maintain budget neutrality.  For 2019, the maximum negative adjustment is 4%, but this number will increase up to 9% in 2022. 

 

Performance Categories and Weighting for MIPS

Performance Category

Description

Weighting (initial performance period, to be applied in 2019)

Reporting Required?

Quality

6 measures with at least 1 outcomes measure; Replaces PQRS and the quality component of VBPM

50%

Yes

Cost (Resource Use)

Score based on claims submitted to Medicare; Replaces the cost component of VBPM

10%

No

Clinical practice improvement activities (CPIAs)

Activities focusing on coordination of care, safety, and beneficiary engagement; Providers can choose from >90 options

15%

Encouraged (but not required)

Advancing care information

Replaces meaningful use of EHR; Emphasis on information exchange and inter-operability

25%

Encouraged (but not required)

 

MACRA contains 22 performance criteria for imaging-based practices. Three key areas of focus for imaging-based practices include radiation dose management, follow-up recommendations, and external image sharing. 

 

For more detailed information on MACRA, click here (insert link for the following site:  https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html)

Reference: The Advisory Board. “5 MACRA Takeaways for Radiologists.” May 4, 2016.

Back to Advocacy FAQ


 

703-766-1706
800-876-4195

415 Church St. NE, Suite 204
Vienna, VA 22180-4751