The Stoltenberg Blog

Healthcare technology insights for competitive value-based care strategy

Defining MACRA: What Is It, and How Will It Impact Your Organization?

Archived Content

The first reporting year of the Medicare Access and CHIP Reauthorization Act (MACRA) is officially underway, but many physicians and healthcare organizations across the country still struggle with comprehending where they stand. Providers no longer have time for guessing. Instead, healthcare organizations must create and maintain strategic plans for reimbursement, covering everything from who will head MACRA initiatives to what reporting measures best match organizational strengths. Let's begin by answering some key questions about the final rule.

What is it?
MACRA replaces the old sustainable growth-rate (SGR) formula for physician payment, transitioning focus from fee-for-service to value-based care. Clinicians now need to pick from one of two reimbursement tracks: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

APM versus MIPS
A lot of confusion can arise when physicians try to understand what path under MACRA is best suited to their business. With the initial reporting year already underway, if you're unsure of your path, you're likely not reporting under APMs. The Advanced APM track offers practices the opportunity to earn more in exchange for taking on some risk related to patient outcomes. Models qualifying for 2017 reporting include the Comprehensive ESRD Care Model (Large Dialysis Organization arrangement), Medicare Shared Savings Program (Track 2), Medicare Shared Savings Program (Track 3), Next Generation ACO Model, Comprehensive Primary Care Plus (CPC+) and Oncology Care Model Two-Sided Risk Arrangement. In 2017, under the Quality Payment Program, clinicians may earn a 5 percent incentive payment through participation in these Advanced APMs.

The other option, MIPS, is based on reporting quality metrics, resource use, clinical practice improvement and advancing care information categories. Performance tracking for MIPS began January 1, 2017, with reported data submission due by March 31, 2018, for the 2019 adjustment payment period. In this initial 2017 performance year, physicians can earn or lose a potential 4 percent of their reimbursement. Those exempt from MIPS reporting are providers who do not generate at least $30,000 in Medicare Part B billing, and those who do not provide service to at least 100 Medicare patients per year. For the 2018 reporting year, CMS is now proposing to amend exemption threshold to $90,000 and 200 Medicare patients per year to help small practices.

The difficulty with MIPS is determining the metrics for reporting that best align with physician care and organizational strengths. Also, physicians have options within this first year toward what reporting pace they're utilizing.

The significance of MACRA moving forward
No matter your health organization's reporting path, MACRA requires physicians to properly capture, maintain and analyze data from both financial and clinical areas to maximize their reimbursement opportunity. In the transition to value-based care, MACRA pushes healthcare providers to be more strategic and stringent with their data to meet reporting requirements, prepare for future regulation changes and cater to today's evolving patient needs.