Many physicians (aka Eligible Professionals and Hospitals) rejoiced at hearing the 'death' of MU when CMS's acting administrative director Andy Slavitt said 'Meaningful Use (MU) Program as we know it is effectively over' on January 11, 2016 at the J.P. Morgan Healthcare Conference..Alas! We failed to really listen to all of his words.

MACRA Impact on Medicare Payments

MACRA impacts Medicare payments in three ways. It repeals the Medicare sustainable growth rate (SGR) formula that calculated payment cuts for physicians.It creates a new framework for rewarding physicians for providing higher quality care by establishing two tracks for payment. The Merit-based Incentive Payment System (MIPS) and the Alternative Payment Models (APMs).

The Merit-based Incentive Payment Program (MIPS) omits requirements such as clinical decision support and computerized provider order entry in physician electronic health-records. Providers are allowed to choose from a number of categories. CMS seeks to correct the all-or-nothing approach that was a common gripe lobbed at the meaningful-use rules.

The HIT component of MIPS will require providers to demonstrate that their EHR system isn't “data-blocking.” This may be a new term to most physicians and also made challenging as data-blocking references a broad range of activities that create direct and in-direct impediments to the sharing of information among EHR vendor platforms, often for competitive reasons.

Who Is Impacted?

2016 is the final year physicians will be subject to penalties under the meaningful use program as it’s configured now, and 2017 will be the first year physicians will be assessed based on the new advancing care information program. Any penalties levied based on meaningful use attestations from this year would be assessed in 2018.

For now, only physician offices—not hospitals—are governed by MACRA rules. In addition, this program only applies to payments physicians receive from Medicare. Medicaid is not included.

MACRA consolidates three existing quality reporting programs, plus adds a new program, into a single quality system through the MIPS. This is a new program that combines parts of thall the following incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

  1. Physician Quality Reporting System (PQRS)
  2. Value Modifier (VM) or Value-based Payment Modifier
  3. Medicare Electronic Health Record (EHR) Meaningful use (MU)
  4. Clinical practice improvement activities (CPIA)



2017 performance determines payment in 2019

Medicare payments or penalties under MACRA being handed out starting in 2019. But the challenge for providers is that the Centers for Medicare and Medicaid Services (CMS) plans to use data collected in 2017 to determine payment adjustments for 2019.

Further complicating things for physicians is that under MACRA, physicians must choose between two distinct paths toward payment. Either the merit-based incentive payment system (MIPS) or an advanced alternative payment model (APM).

Most eligible professionals will probably report through the Merit-based Incentive Payment Program (MIPS) in the first year of the program. That data will then be used by CMS to determine which providers met the requirements for the APM track. Physicians are not locked into their choice—they can switch between MIPS and APM annually.


HIT Consulting Pricing

MACRA Consulting and Planning assistance for Covered Entities and their Business Associates. Got a question>? Need a quick answer? JReady to get started creating your roadmap for MACRASuccess today? Check out our flat-rate per half-hour pricing for quick issues or questions. We also create custom pricing for large and small projects and more complex efforts! Contact us today!