MACRA Resource Center

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 The bipartisan law repealed the Sustainable Growth Rate (SGR) formula used to determine Medicare physician fee-for-service payments.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. 

1. Learn about the new Quality Payment Program and select the path best suited for your practice. 
2. Assess your performance under Medicare's current quality programs.
3. Review and select quality measures and reporting mechanism.
4. Contact your EHR vendor, and review and select Advancing Care Information (ACI) measures.
5. Review and select practice improvement activities and reporting mechanism.

This checklist is based on the final rule.

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 practice.consulting@texmed.org, 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.