MACRA: Big Changes

There’s a reason why the “Medicare Access & CHIP Reauthorization Act” (MACRA) is also called the “permanent doc fix”. MACRA permanently eliminates the sustainable growth rate (SGR) formula (and its annual threat of physician payment cuts) and provides positive annual payment updates lasting through 2019.

Right now, Medicare measures the value and quality of care through a combination of programs. Some doctors and clinicians are part of Alternative Payment Models such as the Accountable Care Organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program. Others participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.

According to the Department of Health and Human Services (HHS), MACRA’s primary goal is to structure this mishmash of value-based payment models that have increasingly replaced the traditional fee-for-service system via a new framework called the Quality Payment Program. Doctors are provided with two paths for compliance:

  • The Merit-based Incentive Payment System (MIPS). MIPS scores clinicians on four performance categories based on flexible measures and activities chosen by physicians based upon their specialty.


  • Advanced Alternative Payment Models (APMs), including the Comprehensive Primary Care Plus and Next Generation ACO models, among others.

Whichever path organizations choose, big changes are coming for them and for the way they get paid. Payments through either path will be based on quality of care, rather than the number of services provided.

Doctors need to have interoperable electronic health records and options for treating patients. MACRA regulations should be flexible as practices need to figure out what works best for them. A large hospital system will have completely different needs than a solo practitioner in a rural area.
Doctors and hospitals need the opportunity to determine what payment models and health record systems are the best fit for them. They’ll need resources to make changes while continuing to serve patients.

A higher focus on quality will challenge organizations to track and manage patient information in a widely new way. Instead of simply charging a set fee for each service, they’ll need to systemize care and share information with other healthcare systems.

The fact is that changes are coming for organizations and the way they get paid. Payments will be based on quality of care, rather than the number of services provided. MACRA will have a significant impact on the finances of hospitals and practices and the way they deliver care.

Big changes will not happen overnight and it will take some transition time to succeed. These are exciting and challenging times for us all.


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