Defining MACRA: What You Need to Know

Date: February 10th, 2016Category: CORHIO e-NewsletterTopics: MACRA, Transformation Support Services, Merit-Based Incentive Payment System (MIPS)


The new buzzword in healthcare seems to be MACRA. Here’s a brief overview of what MACRA is as well as an explanation of the two main components. 

On April 16, 2015, President Obama signed in to law the Medicare Access and CHIP Reauthorization Act or MACRA. MACRA is known as the “doc fix” bill because of its financial effect on how providers are paid by Medicare. MACRA repealed the Sustainable Growth Rate (SGR) formula that has created uncertainty in Medicare payments to physicians for over a decade. In addition to the end of SGR, the new law outlines a path from traditional fee-for-service to rewarding value over volume through two payment tracks: Merit-Based Incentive Payment System (MIPS) and Alternate Payment Models (APM).

To view the MACRA timeline, visit the CMS page.

What is MIPS?

MIPS consolidates three current programs: the EHR Incentive Programs/Meaningful Use, Physician Quality Reporting System (PQRS) and Value Based Payment Modifier (VBPM) into one quality program.

MIPS will evaluate four performance categories: Quality, Resource Use, Clinical Practice Improvement Categories and Meaningful Use of certified EHR technology. An eligible professional’s (EP) performance score will be used to determine if an EP receives a positive, negative or no payment adjustment. MIPS provides an opportunity for providers to receive incentives based on care that works towards the Triple Aim -- better care for individuals, better health for populations and reduction of per-capita costs.

What are APMs?

MACRA promotes the development of an eligible professional’s participation in Alternate Payment Models (APMs), which create a payment incentive program for qualifying participants. According to CMS: “APMs are new approaches to paying for medical care through Medicare that incentivize quality and value.” Accountable Care Organizations, Patient Centered Medical Homes and bundled payment models are examples of APMs.

For more information, please visit the CMS MACRA information page and the Path to Value document.

CORHIO’s Transformation Support Services team can help you through MACRA, MIPS, Meaningful Use and more. Contact us today.

“Improving the way providers are incentivized, the way care is delivered, and the way information is distributed will help provide better care at lower cost across the health care system…”

Sylvia Burwell
Secretary of Health and Human Services