MACRA – What is it?

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is a bipartisan legislation signed into law on April 16, 2015.

MACRA created the Quality Payment Program that:

  • Repeals the Sustainable Growth Rate (PDF) formula
  • Changes the way that Medicare rewards clinicians for value over volume
  • Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
  • Gives bonus payments for participation in eligible alternative payment models (APMs)

The Quality Payment Program has two tracks you can choose based on their practice size, specialty, location, or patient population:

To be successful under either, groups are required not only to track measures and activities but to perform well in those areas—and even to outperform their peers.

How will the QPP impact my Medicare Payments?

Medicare Access and CHIP Reauthorization Act (MACRA) significantly changes how Medicare will reimburse physicians in the future. So depending on the data you submit for the performance year, in the payment year, your Medicare payments will be adjusted up, down, or not at all.

Payment adjustment for the performance year 2022 will be in the payment year 2024 ranges from -9% to +9%, based on the final score. So, if you don’t send in any 2022 data, then you will be subject to a negative 9% payment adjustment.

If you decide to participate in an APM, you may earn an incentive payment for providing high-quality, high value care and cost-efficient care. APMs can focus on specific clinical conditions, care episodes, or populations. If you decide to participate in MIPS, you will earn a performance-based payment adjustment for the services you provide to Medicare patients.

Who is in the Quality Program?

MIPS eligible clinician types are as follows

  • Physician (including doctor of medicine, osteopathy, dental surgery, dental medicine, podiatric medicine, and optometry)
  • Osteopathic practitioner
  • Chiropractor
  • Physician assistant
  • Nurse practitioner
  • Clinical nurse specialist
  • Certified registered nurse anesthetist
  • Physical therapist
  • Occupational therapist
  • Clinical psychologist
  • Qualified speech language pathologist
  • Qualified audiologist
  • Registered dietitian or nutrition professional
  • Clinical social workers
  • Certified nurse-midwives