The Medicare Access and CHIP Reauthorization Act (MACRA)
On January 1, 2017, physicians, providers, and health care providers will embark on the era of MACRA, the Medicare Access and CHIP Reauthorization Act of 2015, which will dramatically change how providers are paid by the Centers for Medicare and Medicaid Services. Signed into federal law by President Obama on April 16, 2015, MACRA is a fix for the unsustainable Sustainable Growth Rate (SGR) formula.
On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) published its final rule on of the Quality Payment Program (QPP) creating a flexible system for physicians and other eligible providers to select between two paths connecting quality to payments. This creates a provider payment system more in line with how healthcare is approached today versus 20 years ago. The QPP pathways seek to tie an increased percentage of physicians’ Medicare fee-for-service (FFS) payments to outcomes through the new Merit-based Incentive Payment System (MIPS) and to encourage the adoption of “alternative payment models” (APMs) which will require practices to take on more financial and technological risks. According to the MACRA rules, providers will be able to switch between the MIPS and the APM track on a year-to-year basis.
On September 8, 2016, Acting CMS Administrator Andy Slavitt acknowledged the concerns and trepidation of meeting reporting requirements by announcing 2 additional 2017 data submission options to give providers additional time to submit Quality Payment Program data. With a total of four reporting options, providers can choose to submit data for the entire year, they can submit data for a part of the year, they can submit any data before the end of the year, or they can decline to submit any data during 2017. Each choice will be accompanied by positive or negative payment adjustment.