MACRA

Most Frequently Asked Questions on MACRA for PA/LTC

Payment Reform and Quality Reporting Under MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) makes four important changes to how Medicare pays those who give care to Medicare beneficiaries. 

  • Ending the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services.
  • Updated the rates for physician services will increase each year by 0.5 percent through 2019; by 0 percent from 2020 through 2025; and then beginning with 2026, by 0.75 percent for physicians in eligible APMs and 0.25 percent for all others.
  • Making a new framework for rewarding health care providers for giving better care not more just more care.
  • Combining our existing quality reporting programs into one new system.

The enactment of MACRA represents a major turning point in Medicare Part B payment policy and quality programs, which could have a significant impact on post-acute and long-term care practitioners. These proposed changes, named the Quality Payment Program (QPP), replace a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models.

The MACRA QPP will help to move more quickly toward the goal of paying for value and better care. The Quality Payment Program has two paths:

  1. Merit-Based Incentive Payment System (MIPS)
  2. Alternative Payment Models (APMs)

MIPS and APMs will go into effect over a timeline from 2015 through 2021 and beyond.

What is the Society Doing About MACRA?

The Society submitted comments on MACRA proposed regulations. CMS is set to issue final regulations by Nov 1, 2016.

Some things the Society advocated for:

  • Exempting SNF patients encounters (99304-99316) from resource category of MIPS
  • Exemptions for Advancing Care Information for SNF/NF patient encounters
  • Inclusion of additional Advanced APMs for PA/LTC practitioners
  • Inclusion of additional Practice Improvement Activities under MIPS

What are some educational resources to learn more about MACRA?

  • CMS Website
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  • Comprehensive PowerPoint Presentation on MACRA Proposed Rule
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  • The Society Webinar – Role of QIOs in Payment Reform
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  • The AMA Payment Model Evaluator is an innovative tool offering initial assessments to physicians so they can determine how their practices will be impacted by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Developed with the expertise of physicians and input from partners, the tool will give physicians and their staff a brief assessment, as well as relevant educational and actionable resources. Once physicians and medical practice administrators fill out the online questionnaire, they will receive guidance for participating in the MACRA payment model that is best for them. The AMA will continually update the Payment Model Evaluator to respond to regulatory changes and to keep practices up to date throughout the new payment and care delivery reform process. The tool is free to all physicians and their practice administrators.
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  • The AMA STEPS Forward™ collection of practice improvement strategies has new MACRA-specific tools. Accurate and successful reporting on quality metrics is crucial to the new Medicare payment system, both in the current Physician Quality Reporting System program and under MACRA’s new Quality Payment Programs. Each STEPS Forward module focuses on a specific challenge and offers real-world solutions, steps for implementation,, case studies, continuing medical education, and downloadable tools and resources. Physicians and their practice staff can use these to help improve practice efficiency and ultimately enhance patient care, physician satisfaction and practice sustainability. The full collection, which now includes 42 modules, has a variety of tools that will help physicians and their practices, including:
  • Implementing team-based care
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  • Electronic health record selection and implementation
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  • Preparing practices for value-based care
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  • Implementing team documentation
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  • Quality Reporting and the importance of Qualified Clinical Data Registries (QCDRs) in maximizing your success
  • The AMA launched a ReachMD podcast series titled Inside Medicare’s New Payment System. Andy Slavitt, acting administrator of the Centers for Medicare and Medicaid Services (CMS), Dr. Gurman, AMA staff experts, and others are featured on the series, which will include five episodes to help physicians be informed on upcoming Medicare changes.
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  • ACP: MACRA Ready Resources

How do I learn more about reporting on MIPS?

Click here for more information on MIPS reporting

How do I learn more about participating in APMs?

Click here to learn more about APM participation.