May 23, 2019

What Is MACRA?

MACRA, or the Medicare Access and CHIP Reauthorization Act, was passed in 2015 and permanently changed the way that Medicare pays healthcare professionals. Every medical practice that works with Medicare needs to understand the implications of this law and the current implementation timeline. Thankfully, it’s not as complicated as it sounds!


The primary goal of this initiative is to improve overall patient health and reward the practices that succeed in doing so while maintaining or lowering costs. Before the bill was passed, physicians were compensated based on the number of services performed. Now, the healthcare system is being shifted to a model where professionals are paid based on quality of care instead. Medicare wants to reward clinicians for providing value over volume of care.

Within MACRA, there are two types of payment models: the Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS). The good news is that you are most likely already following one of these models, as they are very similar to previous CMS incentive programs, such as PQRS and Meaningful Use.

The Quality Payment Program

One of the changes created by MACRA was the creation of the Quality Payment Program (QPP). All Medicare physician assistants, nurses and physicians need to participate in MIPS or APMs, and they receive a positive, negative or neutral Medicare payment adjustment as a result.

MIPS grades professionals based on resource use, clinical practice improvement, quality and meaningful use of approved EHR technology. APMs create different ways for healthcare practices to get paid for the care that they provide, including accountable care organizations, bundled payment models and patient-centered medical homes.

American Academy of Family Physicians provides a graph illustrating the quality measure and their weight in the upcoming several years:

Performance Category 2019 2020 2021
Quality 45% 40%* 35%*
Cost 15% 20%* 25%*
Promoting Interoperability 25% 25% 25%
Improvement Activities 15% 15% 15%

*Estimated weights

 To further emphasize the importance of value based care, CMS has created a new website called Physician Compare, where patients can search for providers who participate with Medicare and view their quality program performance. They can compare up to three clinicians at a time to see which provider is best for them. Keeping a high ranking will be imperative in the future, not just for higher reimbursement, but for attracting and keeping patients.

What Changes Have Occurred in 2019?

  • An additional exemption category has been added. The current exemptions for the QPP are for practices that provide less than $90,000 in Medicare Part B charges for covered professional services, provide 200 or fewer covered physician services or care for 200 or fewer Medicare beneficiaries.
  • Quality performance has changed from 50% of the score to 45% of the score, and cost has increased from 10% to 15%.
  • Payment adjustments will be higher in 2021 and range from -7% to 7%.
  • Small practices of 15 or fewer eligible physicians will receive a quality performance bonus of 6 points.
  • If a group meets one or two low-volume exception categories, they can still choose to opt in to MIPS.

Run Your Practice More Efficiently with Medical Business Partners

Medical Business Partners specializes in workflow optimization, dynamic solutions and a wide range of services designed to help medical practices grow and thrive. To learn more about our billing services, start-up consulting, credentialing services or something else, please contact us through our website or by calling (202) 390-3966.

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