What is MACRA and why does it matter to you?


Medical leadership preparing their organization for MACRAMACRA, or Medicare Access and CHIP Reauthorization Act of 2015 is bipartisan legislation that was signed into law in 2015.  In order to begin implementing the provisions in this legislation, the Department of Health and Human Services (HHS) issued a proposal in April 2016 to align and modernize the way Medicare payments are tied to the quality and cost of patient care.

This proposal would replace the existing Sustainable Growth Rate (SGR) formula with a new reimbursement plan for Medicare clinicians called the Quality Payment Program. The intention is to promote better care, smarter spending and healthier Americans.

The Quality Payment Program offers two paths for healthcare providers:

  • Merit-Based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs)

Most Medicare clinicians will initially participate in this program through MIPS. MIPS streamlines multiple quality programs including: Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentives.

The reporting period for MIPS begins in 2017, which means CMS would begin measuring performance based on the incentive programs described above in 2017, but payments based on those measures won’t begin until 2019. MACRA will also impact reimbursements by repealing the Sustainable Growth Rate (SGR) formula  and by offering bonus payments for participation in eligible alternative payment models (APMs).

The main goals are as follows:

  1. Tie more payments to value by creating multiple pathways with varying levels of risk and reward
  2. Allow a broad range of providers to participate in APMs over time
  3. Minimize reporting burdens for APM participants
  4. Create an understanding of each physician’s individual status with respect to MIPS and/or APMs.

 Planning for MACRA

The future of the Accountable Care Act and other Obama-era healthcare programs is unknown. However, the significant amounts of time, effort and money already invested by payers and providers make it likely that the transition to value-based care will continue.

With that in mind, your hospital should seek out vendors who can help you with the following:

Readiness assessment. A thorough assessment should consider all areas that may be impacted by MACRA, including PQRS/MIPS/MACRA communications,

clinician structure, payer mix analysis and historical PQRS performance. The assessment should result in a prioritized action plan designed to ensure a successful MACRA rollout.

Transformation planning. Your vendor partner should be able to deliver the necessary transformation planning and strategic management consulting services identified by the assessment. They should offer a roadmap to prepare your organization for the implementation of the new quality payment programs and be able to articulate the steps that will help you control patient care costs, improve outcomes and boost margin growth.

Solution delivery and monitoring. Your vendor partner should be able to help you ensure successful integration and adoption of new pricing models and then help you create meaningful reporting mechanisms and dashboards that will help you ensure a successful MACRA rollout that meets both legislative goals and organizational priorities.

Given the complexities of moving to value-based compensation, organizations that move now to prepare for MACRA will be well positioned to take advantage of new payment models, regardless of the status of the ACA.


Join our workshop on February 8th in Charlotte, NC where we will provide you with the information you need to gain a better understanding of the impact of MACRA on your facility.

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