MACRA – Medicare’s New Payment Plan

Why does our government have to make everything so difficult?  Seriously the first two articles I read simply identified MACRA as the Medicare Access and CHIP Reauthorization Act of 2015 signed into law on April 16, 2015.  Both articles then went on to say that MACRA was going to be a “potential game changer” of our current health care system.  But neither explained why.

I had to dig around quite a bit before I could really get what I would call any understanding of what MACRA is myself.  So this is my layman’s version of MACRA:

•    MACRA repeals the SGR formula (Sustainable Growth Rate) that used to threaten substantial pay cuts to physicians.
•    MACRA will begin being implemented in 2019
•    There are basically two options for eligible providers.  A.  EPs can participate in MIPS, or Merit-Based Incentive Payment System.  MIPS is a modified fee-for-service model which consolidates PQRS, meaningful use, and value-based modifiers.  B.  If they qualify they can participate in the Alternative Payment Models or APMs.  Participation in APM is entirely voluntary.  APMs are new payment and delivery models approved by CMS.
•    MIPS is supposed to promote better care and smarter spending by evaluating EPs.  Evaluations will be based on quality of care, resourse use, clinical practice improvement activities, and meaningful use of EHR
•    There will be incentive payments for qualifying EPs

I will continue to gather information on MACRA and we will include more articles in the future.  For now there is still time for us to figure out how this will impact providers.  There is also time for them to delay the implementation which seems to be common with all new legislation in the medical field.


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