MACRA in a Nutshell


A provider’s fee schedule will be based on their composite score.

Penalties take effect in 2019 but are based on actions taken in 2017.

There are three exceptions.  They are:
1.    Physicians billing less than or equal to $30,000 in charges to Medicare for 100 or fewer patients
2.    Physicians in their first year of enrollment
3.    Physicians participating in APMs

For 2017 & 2018 Requirements are for  Physicians (MD/DO and DMD/DDS), Physician Assistants, Clinical Nurse Specialists, and Certified Registered Nurse Anesthetists

In 2019 it is expanded to include physical and occupational therapists, speech-language pathologists, audiologists, nurse midwives, clinical social workers, clinical psychologists, and dietitians/nutritional professionals

So mental health, physical therapy, audiologists, and a few others are not affected until 2019

There are 4 performance categories:
1.    PQRS  –  60%
2.    EHR  –  25%
3.    Clinical Practice Improvement  – 15%
4.    Resource Use  –  0%  (not used in 2017, but will be in 2018 and on)
This means that a huge 85% of the score is based on PQRS and EHR.