MACRA Highlights

HR 2, The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), was introduced by ACOG Fellow Rep. Michael Burgess, MD (R-TX) and signed into law on April 16, 2015.   The program is sometimes now called the Medicare Quality Payment Program (QPP.)

Key Changes, SGR v MACRA

  1. SGR: Payment changes (cuts) were applied uniformly to all physicians.
    MACRA: Payment increases or decreases apply to individual physicians based on individual physician performance.  

  2. SGR: No financial incentive to improve quality. MACRA: Payment based partially on quality measurement.

  3. SGR: Flawed mathematical formula written into the law, imposed by HHS on physicians.

  4. MACRA: Law, implementation, and programs developed with physicians.

  • Existing Reporting Programs Medicare EHR Incentive Program aka MU (electronic health records meaningful use) 3% penalty, increased to 5% in 2019, for failure to meet standards. 

  • PQRS (Physician Quality Reporting System) 2% penalty for failure to report quality measures.

  • VM (value-based payment modifier): 2016, Practices with 100+ providers, 2% penalty for low VM performance score.

  • 2017, Practices with 1-9 providers, 2% penalty for non-participation in 2015 PQRS. Practices with 10+ providers, 4% penalty for low VM performance score.

  • 2018, All providers subject to possible downward adjustment. 

MACRA:  Streamlines these reporting programs into one.

MACRA Payment Highlights:

  • MACRA eliminates SGR and 21.2% payment cut scheduled for 2015

  • The Physician Fee Schedule is increased by  0.5% payment from  July 2015 through 2019

  • There is no increase in the fee schedule from 2020 to 2025

  • Yearly beginning in 2026, the feed schedule for physicians in qualifying Advanced APMs increases 0.75%, while the fee schedule for MIPS and exempt physicians increases 0.25%.

(2) Payment System Options:  You Choose What Works Best for Your Practice

  1. Merit-based Incentive Payment System (MIPS): FFS plus streamlined reporting on EHR MU/PQRS/VM programs

    1. Sliding-scale bonuses or cuts based on reporting and performance in four categories: quality, resource use, advancing care information (EHR meaningful use), and clinical practice improvement activities, a new category.

  2. Advanced Alternative Payment Models (APM): Highest payment growth potential; no MIPS reporting requirement

    1. Qualifying APMs that physicians can participate in include medical homes, accountable care organizations (ACOs), and demonstrations under the Medicare Health Care Quality Demonstration Program

    2. Physicians practicing within a qualifying APM will receive a 5% bonus between 2019 and 2024 and a 0.75% increase in the Physician Fee Schedule in 2026 and beyond.

Email your questions about the MACRA Quality Payment Program to

Cost-Conscious Cases:

Physicians have a responsibility to our patients and society to “do no harm” which includes providing cost-conscious medical care.

Read more

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