3. How might MACRA change health care payments?

For example, in MIPS, payment adjustments are determined by a Composite Performance Score made up of these 4 components: clinical practice improvement activities (15% of the score), Advancing Care Information program (25%), resource use (10%), and quality achievement (50%). MIPS payments can be adjusted upward or downward based on performance from 2 years ago — these can range from ±4% in the first year of payments in 2019 to ±9% in 2021.

4. What about MIPS and APMs?

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This is a bit complicated. APM’s quality measures are similar to those of MIPS, along with requiring the use of EHRs. APMs provide 5% bonus payments, and to earn this incentive in 2019 and 2020 at least 25% of Medicare revenues must be through an APM. This increases to a minimum of 50% by 2021 and 2022.

MIPS also provides a bonus of up to an additional 10% for physicians in the top 25th percentile of an annual performance standard.

5. What can you and your practice do to prepare?

Start thinking about APM or MIPS.

“Certified PCMHs automatically qualify for the highest possible score for the practice improvement component of the MIPS program (15% of their total score), and as noted above, PCMHs also can qualify as an APM without having to take direct financial risk.”2

To further complicate matters, there are Advanced Alternative Payment Models. Participating physicians are exempt from MIPS. They must meet quality metrics similar to MIPS, use EHR, and bear financial risk “in excess of a nominal amount.”

Keep your eyes and open for updates.

Delve deeper.

If you’re like me, there’s much to learn, and to continue learning. Keep reading up on these changes; ask questions and speak with others and stay tuned.


  1. Belliveau J. Is MACRA a true doc fix for value-based reimbursement? RevCycle Intelligence. Updated July 21, 2016. Available at: https://revcycleintelligence.com/news/is-macra-a-true-doc-fix-for-value-based-reimbursement. Accessed August 12, 2017.
  2. Walker T. Four crucial tips to consider when picking MIPS or APM. Medical Economics. Updated September 22, 2015. Available at: https://revcycleintelligence.com/news/is-macra-a-true-doc-fix-for-value-based-reimbursement. Accessed August 12, 2017.

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