Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015. The bipartisan law repealed the Sustainable Growth Rate (SGR) formula used to determine Medicare physician fee-for-service payments. Physician and congressional leaders say organized medicine’s united voice was instrumental in eliminating the flawed SGR formula, a payment design enacted in 1997 to sustain Medicare with lower costs — but instead threatened physicians with unsustainable payment cuts every year since 2003.
In SGR's place, MACRA requires physicians to choose between two major payment paths: the fee-for-service Merit-Based Incentive Payment System (MIPS), and eligible alternative payment models (APMs).
The first performance period for MIPS and APMs began on Jan 1, 2017. Under MACRA, physicians’ 2017 performance on various quality, cost, technology use, and practice improvement measures will determine cuts, bonuses, or neither in their 2019 Medicare payments.
In late April, the Centers for Medicare & Medicaid Services (CMS) began sending letters to inform physicians and other eligible clinicians about their Merit-Based Incentive Payment System participation status for the 2017 performance period. In May, CMS added a national provider identifier (NPI)-level lookup tool to its Quality Payment Program website. The letters and lookup tool inform individual and group practices about which clinicians associated with a taxpayer identification number (TIN) are eligible for the program and which are exempt. To find out about your status, refer to your letter or access the lookup tool.
Medicare's final rule acquiesces to medicine's call for more flexibility for small practices in the first year but moves full speed ahead with the transition to value-based payment.
Here are some steps TMA recommends you take now to prepare your practice.
This checklist is based on the final rule.
Don’t know where to start? Learn about the new Quality Payment Program using TMA, American Medical Association, and CMS resources and tools.
Texas Medical Association
Alphabet Soup: A MACRA Glossary and Acronym Guide
American Medical Association
Understanding Medicare Payment Reform (MACRA)
Centers for Medicare & Medicaid Services
Quality Payment Program: Merit-based Incentive Payment System and Alternative Payment Models
Quality Measures, Advancing Care Information Measures, and Improvement Activities
Quality Payment Program Education & Tools
Physician-Focused Payment Model Technical Advisory Committee (PTAC)
CMS MACRA Webinars
Learn about MACRA and earn continuing medical education (CME) credits with quality TMA-developed education programs. The following CME opportunities are available to TMA members and their staff either at no cost or at special discounted rates.
TMA Education Center On-Demand Webinar:
TMA Seminar: MACRA and Medicare — Get Clarity and Direction! (recorded Nov. 2016)
MACRA Penalties: Neutralize Them With New Revenue (recorded Sept. 2016)
TexMed 2017 CME Tracks:Quality Payment Programs in Today’s Practice - Day 1, Fri., May 05 Free CMEQuality Payment Programs in Today’s Practice - Day 2, Sat., May 06 Free CME
Improve the business side of your practice and be MACRA-ready.
TMA Practice Consulting offers quality improvement services to help prepare physician practices for the upcoming transition under MACRA. TMA's practice management consultants can conduct a MACRA readiness assessment of your practice and provide customized on-site assistance to help you with your practice's specific needs. The assessment will focus on clinical processes, electronic health record optimization, and workflow improvement opportunities to help increase your MIPS scoring. To learn more, email email@example.com, or call (800) 523-8776.
TMA PracticeEdge provides Texas physicians the technology and expertise to take advantage of new health care payment models. Working with strategic partners, TMA PracticeEdge offers physicians a unique toolkit of ACO services backed by the trusted TMA brand. To learn more, email info@TMAPracticeEdge.com, or call (888) 900-0334.
To help keep you up to date with the latest MACRA news and advocacy, TMA will regularly post relevant information on this resource center.
MIPS Exempt? Check Online Action, May 15, 2017
Are You MIPS Exempt? Word Coming Soon Action, May 1, 2017
Avoid the 2019 MACRA Penalty With Minimal Reporting TMA Practice E-Tips, April 27, 2017
How to Submit the Bare Minimum to Avoid 2019 MIPS Penalty Action, April 3, 2017
Feds Award $100 Million in MACRA Help to Small, Rural Practices Action, March 1, 2017
MACRA: Propose Your Own Physician-Focused Payment Model Action, Feb. 15, 2017
Confused About Quality Reporting? Get Help From TMF and TMA Action, Feb. 15, 2017
MACRA: Review Your Options for Medicare's New Quality Payment Program Action, Jan. 17, 2017
MACRA: Easing the Pain? Texas Medicine, Jan. 2017
TMA Wins MACRA Improvements, Wants More Action, Dec. 15, 2016
Read More About MACRA
Explore the list of federally funded initiatives to help you transition to MIPS or APMs. All services are available to physicians and group practices at no or low cost.
Quality Payment Program – Small, Underserved, & Rural Support
TMF Quality Payment Program Network
Transforming Clinical Practice Initiative
Health Care Payment Learning and Action Network
The Innovation Center’s Learning Systems
TMA reminds you that MIPS will combine parts of the PQRS, VM, and MU programs. If you are new to Medicare’s quality programs or want to know about the latest program requirements, visit TMA’s resource centers to learn more.
TMA Advancing Care Information (ACI) Resource Center
TMA EHR Adoption Resources
TMA Meaningful Use Resource Center
TMA PQRS and VM Resource Center
Got MACRA questions, call or email the Knowledge Center
To help you get the best information possible, TMA has identified direct links to MACRA news, resource centers, education, and advocacy from national specialty societies. Visit your specialty society online for information specific to your specialty, setting, and practice.
See our list.
Subscribe to Centers for Medicare & Medicaid Services (CMS) email lists to stay informed of new policies or changes to relevant Medicare programs and for the latest MACRA information. Stay up to date with MACRA deadlines and compliance dates by visiting TMA’s Deadlines for Doctors.
CMS MACRA Quality Payment Program Email Updates
CMS PQRS Email Updates
CMS EHR Incentive Program Listserv
Medicare Learning Network National Provider Calls and Events
CMS Open Door Forums
CMS Teleconferences and Events