When the Medicare Access and CHIP Reauthorization Act (MACRA) passed and was signed into law in 2015 it marked a sea change in how Medicare reimburses physicians — from volume of services to value.

MACRA replaced the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula; the Quality Payment Program (QPP) will take its place, with 2 main facets: Alternative Payment Models (APMs) and the Merit-Based Incentive Payment System (MIPS).

What does this mean for you and your patients? While I cannot (and would not even want to try to) distill this law’s 962 pages into this brief post, here are 5 potentially pivotal questions:

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1. How does MACRA affect patient care?

The hope and goal is to provide better care. There is an emphasis on quality related to patient outcomes, care coordination, as well as greater patient engagement in their care — including patient access to their electronic health record (EHR), offering the ability to send and receive secure messages within the EHR, and enhanced patient education and activation. Will these changes promote improved care?

2. What’s the impact on physician reimbursement?

Most physicians will participate in MIPS, since there are only 3 categories of exempt providers:

  • physicians who care for 100 or fewer Medicare Part B patients or have <$30,000 in Medicare Part B-allowed charges
  • physicians in their first year of participating in Medicare Part B
  • physicians who are eligible to participate in AAPMs or who qualify for the APM bonus

Small practices may absorb a larger, negative impact. The Centers for Medicare & Medicaid Services (CMS) estimates that about 90% of solo practices will face negative adjustments, and 70% of practices with 2 to 9 clinicians.

There’s also much more reporting of data, such as the metrics included above.

The author of the National Center for Policy Analysis’ (NCPA) report on MACRA, Senior Fellow John Graham, noted, “Future regulatory and legislative reforms must do both more and less than the currently proposed rule does. They must reduce the role of the federal government in setting fees for physicians and determining what quality is, while continuing to move the locus of control to patients and doctors, [and] by continuing to move away from paying for individual procedures toward paying for episodes of care.”1