MACRA

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In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The law:
  • Repeals the sustainable growth rate methodology for determining updates to the Medicare physician fee schedule
  • Establishes annual positive or flat fee updates for 10 years and institutes a two-track fee update beginning in 2019
  • Establishes the Merit-Based Incentive Payment System (MIPS) that consolidates existing Medicare quality programs.
  • Establishes a pathway for physicians to participate in an Alternative Payment Model (APM).

Pick Your Pace

  • Option 1—Test the Quality Payment Program (QPP). If you submit some data to the QPP, including data for services provided after Sunday, January 1, 2017, you will avoid a negative payment adjustment in 2019.
  • Option 2—Participate for part of the calendar year. You may choose to submit QPP  information for a reduced number of days. This means your first performance period could begin later than Sunday, January 1, 2017, and your practice could still qualify, potentially, for a small positive payment adjustment. Like option 1, if you submit data, you avoid penalties in 2019.
  • Option 3—Participate for the full calendar year. For practices that are ready to participate on Sunday, January 1, 2017, you may choose to submit QPP information for a full calendar year. This means your first performance period would begin on Sunday, January 1, 2017. Practices selecting this option would be eligible for full positive payment updates in 2019, but they also could face potential penalties depending upon performance.
  • Option 4—Participate in an APM. Instead of reporting quality data and other information through MIPS, the law allows physicians to participate in the QPP by joining an APM, such as the CPC+ program. If your practice receives enough of your Medicare payments or see enough of your Medicare patients through the Advanced APM in 2017, then you would qualify for a 5% incentive payment in 2019.

On October 14, 2016, CMS released the final rule which addresses many of the concerns family physicians have expressed about the complexity of the program, the pace of implementation, new administrative burdens, and the usability of technology. The rule also accommodates physicians by providing technical assistance that will be valuable as they work to fully participate in the QPP and its two pathways.

Prepare to Participate Now

Following are activities you can start immediately to prepare your practice for a profitable transition:
  • If you have not been reporting for the Physician Quality Reporting System, it’s time to start.
  • If that’s off the table, you should at least understand how to report quality measures; the American Academy of Family Physicians has resources to help.
  • Review your practice’s Quality Resource and Use Reports (QRURs) because they will tell you where you stand in the resource use category—one of four categories that will determine future payments in the MIPS track (you need to know now if you are a high utilizer of resources because that will count against you).
  • Start evaluating your practice in terms of clinical practice improvement activities—such as access to care, patient engagement, and care coordination as that will be measured when MACRA is implemented.

CMS Resources

AAFP News and Resources

Additional Resources


Background

On April 14, 2015, the U.S. Senate passed the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 (HR 2) by a vote of 92-8. The legislation was previously passed by the House 392-37 on March 26, 2015. President Obama has subsequently signed the act into law.

MACRA repeals the flawed Medicare sustainable growth rate (SGR) formula that calculates payment rates to physicians. The legislation establishes the following alternative set of annual payment updates to replace the SGR:
  • July-December 2015: Medicare physician payments would remain at the pre-April 1, 2015, level
  • 2016-19: Medicare physician payments would increase 0.5% each year
  • 2020-25: Medicare physician fee-for-service payments would remain at 2019 levels

The legislation also establishes two payment tracks for physicians that would offer bonuses beginning in 2019 and differing payment updates starting in 2026—one for physicians who participate in an alternative payment model (APM) such as the patient-centered medical home and another for those who stay in fee-for-service and participate in the Merit-Based Incentive Payment System (MIPS).

This legislation implements Medicare physician payment reforms that facilitate expanded access, innovation, and quality improvement. The bill expands access to care for children and vulnerable populations, and extends the Children’s Health Insurance Program, community health centers, National Health Service Corps, and the Teaching Health Centers programs. It also ends a 17-year struggle that introduced unwarranted uncertainty into the Medicare program for patients and their physicians.

On April 27, 2016, CMS released a proposed rule to guide implementation of MACRA. Under the new law, various quality payment programs affecting physicians and other health care professionals will be merged into a single framework to transition from payments based on volume to payments based on value. The proposed rule implements these changes through the Quality Payment Program (QPP) which includes two paths, MIPS and APMs.

On June 24, 2016, in response to the release of CMS’s proposed rule on MACRA implementation, the AAFP submitted a letter to CMS brimming with recommendations to consider along with an executive summary of its comment letter. The Ohio Academy of Family Physicians also submitted a letter to CMS supporting the AAFP’s comment letter.

The AAFP continued to press CMS on the items included in its letter and was pleased to report that CMS was listening. On September 8, 2016, through a blog posting by CMS Acting Administrator Andy Slavitt, CMS announced the “Pick Your Pace” program that allows physicians greater flexibility in the initial performance year of MACRA, which is 2017.

The changes included in the Pick Your Pace program do not address all of AAFP’s concerns, but they do create an opportunity for all physicians, regardless of practice size and location, to engage with the QPP and avoid payment penalties in 2019.