Medicare Access and CHIP Reauthorization (MACRA) Act of 2015

Macra 4I have already spent several hours studying MACRA and I will be delusional if I think I’m anywhere close to be done with this.  For those of you that have not heard this acronym let me assure you that if you practice medicine in the USA it will not be long before you become familiar with the acronym. MACRA stands for the Medicare Access and CHIP Reauthorization (MACRA) Act of 2015 and the same amends section 1848(a)(8)(A) of the Social Security Act affecting the quality reporting programs and payment methods to Providers and organizations.  Under MACRA the Merit-Based Incentive Payment System (MIPS) and incentive payments for participation in eligible alternative payment models beginning in 2019 was created. Again in an effort to keep it simple, MIPS replace the sustainable growth rate (SGR) formula and some of its components include:

  •  MIPS Adjustment Factor/Scoring
  • Composite Performance Score
  • Performance Threshold

MIPS also “absorbs”/integrates portions of PQRS, EHR Meaningful Use and Value-based payment modifiers.  There are several changes and depending on what you do is how you will get paid.  There are also new measures and even new measure groups.  For example under PQRS there are three new Measure Groups:

  • Cardiovascular  Prevention
  • Diabetic Retinopathy
  • Multiple Chronic Condition

So for now I will recommend everyone to get familiar with this new Act and start brainstorming your options under the same so you can have some control in terms of your services and expected future payments.