MACRA: MIPS and APMs

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What MACRA, MIPS mean for you

A trend has emerged in healthcare reimbursement: payments tied to quality, rather than quantity. MACRA encourages new strategies with the move to quality-based care.

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) repealed the Sustainable Growth Rate and introduced the Quality Payment Program.

Intended results

Comprehensive care through two tracks: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

Effect on practices

How you get paid has changed. Rather than continuing a fee-for-service model of reimbursement, MACRA introduced the new payment paths.

So ... what is MIPS?

MIPS combines the former Physician Quality Reporting System (PQRS), Meaningful Use (MU), and the Value-based Modifier, which had final performance periods in 2016. It incorporates a new element called Clinical Practice Improvement Activities.

Each year, providers receive payment adjustments based on their performance in four categories — which are shown in the infographic here and described below.

Chart explaining how medical practices will be scored from 2017 until 2022 under MACRA and MIPS.

MIPS scoring categories

Quality: Formerly PQRS, this evaluates providers on their performance on clinical quality measures.
Cost: Formerly the Value-based Modifier, this evaluates providers on the cost of patient care.
Advancing Care Information: Formerly Meaningful Use, this evaluates providers on how they use technology, with an emphasis on patient engagement and interoperability.
Clinical Practice Improvement Activities: Clinical practices or processes that, according to the Secretary of Health and Human Services, will result in improved outcomes. For example, providing patients with 24/7 access to care.

Three doctors looking through data on a computer screen.

Advanced APMs

Participation in Advanced Alternative Payment Models (APMs) exempts a provider or group from MIPS reporting and payment adjustments. These value-based contracts include an element of financial risk, such as shared losses. CMS encourages providers to participate in this track.

In 2017, Medicare Shared Savings Program tracks 2 and 3, Comprehensive Primary Care Plus (CPC+), and Next Generation Accountable Care Organizations (ACOs) were all included.

The rule will continue to evolve over time.

To learn more, check out this Greenway Health webinar.

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