In April 2015, Congress passed the Medicare Access and CHIP Reauthorization Act, which repealed the Sustainable Growth Rate—a method used by the U.S. Centers for Medicare and Medicaid Services (CMS) to control Medicare spending on physician fees and services. In response to the bill passing, two new payment systems were created: the Merit-Based Incentive Payment System (MIPS) and the Alternative Payment Method (APM). The development of these two new payment systems represents the transition away from reimbursement based on fee for service to reimbursement based on quality (among other factors). Physicians will now choose to participate in either MIPS or an APM. Between 2015 and 2018, physicians who participate in Medicare will see a 0.5 percent payment update each year. In 2019, the MIPS/APM reimbursement methods take effect.
MIPS measures physicians on four measures: quality, resource use, clinical practice improvement and advancing care.
APM is a new way to provide care to Medicare beneficiaries. It provides an annual lump sum payment of five percent to physicians participating at certain threshold levels but shifts a greater burden of risk to physicians. An example of an alternative payment model is the Comprehensive Care for Joint Replacement model.
The U.S. Department of Health and Human Services (HHS) will provide $100 million worth of grants—$20 million per year for five years—to provide MACRA education and training to individual Medicare providers or providers in groups 15 and smaller. Refer to HHS' press release for more information.
MACRA Resources
- Executive Summary of the Final Rule
- American Medical Association: Medicare Physician Payment Reform Page
- American Podiatric Medical Association: MACRA Resources
- Explanation of the Main Differences Between MIPS and APMs
- In-Depth Look at MIPS
- CMS: Quality Payment Program
- MACRA Comment Letter
Continue to check this page for information as it is made available.