MACRA was enacted to replace the Sustainable Growth Rate Model with a value-based system, in order to provide physicians with a more sustainable payment system. Physicians are now rewarded for value rather than volume with the Quality Payment Program created by MACRA. While there is a significant upside for those who have stronger scores, payments from CMS can also result in penalties, if organizational weaknesses are not identified and improved and in turn reporting is not done accurately. It is important to note that MACRA applies only for Medicare Part B (physician services) and Children’s Health Insurance Program (CHIP).
Merit Based Incentive Program (MIPS)
MACRA streamlines multiple quality programs under MIPS. MIPS establishes four performance categories – quality, cost, promoting interoperability and improvement activities – which are used to calculate each provider’s composite performance score based on which reimbursement amounts are adjusted. Eligible physicians are evaluated on their performance relative to other physicians in the United States and receive a positive, neutral, or negative adjustment to their payments in a future payment year.
Advanced Alternative Payment Models (AAPMs)
AAPMs financially rewards healthcare providers who deliver high-quality, cost-effective medical care. If clinicians achieve certain requirements through AAPMs, they are offered a 5% incentive payment in addition to any model-specific payments they receive, and are excluded from the MIPS reporting requirements and payment adjustments.
