MACRA Resource Center

Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015, which repealed the Sustainable Growth Rate (SGR) formula used to determine Medicare physician fee-for-service payments. 

In SGR’s place, MACRA requires physicians to choose between two major payment tracks: the fee-for-service Merit-Based Incentive Payment System (MIPS), and advanced alternative payment models (APMs). To enable this, the Centers for Medicare & Medicaid Services (CMS) created the Quality Payment Program (QPP) to implement the two tracks for eligible physicians and other clinicians.

The QPP is an annual program that affects Medicare payment two years later. The objective of the program is to incentivize physicians to improve care; reduce costs; and advance health care information among physicians, allied providers, and patients. The third QPP performance year spans Jan. 1 - Dec. 31, 2019. 

Under the QPP, physicians in MIPS are paid fee-for-service with payment adjustments (incentives or penalties) two years after each performance year. Payment adjustments will vary depending on individual or group performance in four MIPS categories: quality, cost, improvement activities, and promoting interoperability. The payment adjustment in 2021 will be +/-7 percent based on your MIPS score in 2019.

Physicians who take part in an advanced APM in 2019 are exempt from MIPS and may earn a 5-percent incentive payment for participating in an innovative payment model, in addition to APM-specific rewards.

To find out if you are eligible and required to participate in MIPS for the 2019 QPP performance year, check the QPP lookup tool. When you review your profile, take note of any designation assigned to you under “other reporting factors” (e.g., small practice, rural practice, health professional shortage area, facility-based) and learn about what these factors mean to your practice. Physicians required to participate in the 2019 QPP must submit data to CMS by March 31, 2020. If you have questions about your participation status, contact the QPP Service Center at (866) 288-8292, or by email at QPP[at]cms[dot]hhs[dot]gov.

Review the full 2019 QPP timeline and stay on top of MIPS and APM deadlines, snapshots, and milestones.

TMA Practice Consulting offers quality improvement services to help prepare physician practices for 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 Physicians Advocacy Institute, in collaboration with health care consulting firm Healthsperien and TMA, created a MACRA QPP physician education initiative and separate resource center to make the program easier to understand. The website is free, designed for all levels of physician knowledge on the MACRA QPP, and complements TMA’s MACRA Resource Center. Visit the MACRA QPP Resource Center to access free resources and subscribe to the QPP Roundup newsletter.

• TMF Quality Payment Program Learning and Action Network
• Submit a request online
• Email TMF at:
  QPP-SURS[at]tmf[dot]org (15 or fewer clinicians) 
• Call 1-844-317-7609 or live chat Monday through Friday, 8 a.m. to 5 p.m. CT, to speak with a TMF consultant.