The other day I was trying to explain the changes to Meaningful Use and the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to one of my clients. At the time there were so many variables to consider that unless I spent quite a few hours with him there was no way he would have been able to understand. The reality is that Medicare payment and Eligible Provider Quality is currently been measured by a collage of laws, regulations and programs. By now most EPs are familiar with the Medicare Electronic Health Record (EHR) Incentive Program also known as Meaningful Use as well as the Physician Quality Reporting System (PQRS) and the Value Modifier Program. In addition to those we have Accountable Care Organizations, the Comprehensive Primary Care Initiative and the Medicare Shared Savings Program to consider when thinking about payment and quality measurements. Meaningful Use alone is not easy to follow as every couple of months it seems that new changes are needed in order to meet that particular program requirements. Now a new rule comes into place to change everything. The new rule which was unveiled April 27, 2016 will not come into effect until January 1st , 2017 and the same will change how Medicare payments will be tied to cost and quality of patient care. This new Quality Payment Program is expected to roll all the previously mentioned regulations and laws into one. The actual rule is expected to be published in the Federal Register May 9, 2016 and the same refers to two basic paths: • Merit-based Incentive Payment System (MIPS). Under this option EPs will be allowed to choose measures and activities appropriate to the type of care they provide. • Advanced Alternative Payment Models (APMs). The APM option requires the EP to take more risks, with the corresponding benefits. However, many EPs may not meet the law’s requirements to participate in the most advanced models. Based on the above it seems that the Meaningful Use program is no more. Yet, as Ms. Kate Goodrich, director of CMS’ Center for Clinical Standards and Quality, stated; “these changes only apply to EPs in the Medicare Meaningful Use program, who will be transitioning out from that program. However, penalties for Meaningful Use for Medicare clinicians won’t end until the end of 2018 (for performance year 2016).” Another thing to keep in mind is that the HITECH audits will also continue. Keep in mind that HITECH audits for Meaningful Use may be done for any year as long as they do not exceed six years from the records been audited. In other words, Meaningful Use HITECH audits may be around until the year 2024. In summary, changes are going to continue and we strongly advised you to learn the rules of the game if you are going to play.