The Medicare Access and CHIP Reauthorization Act (MACRA) became law in 2015. But this is the first year that MACRA has actually started to affect payments to providers. Naturally, many practices have questions about how MACRA works and where they can find answers related to this very significant change.
MACRA, MIPS, and AAPM
The intention of MACRA is to institute a new way to reward practices for high performance coupled with quality healthcare outcomes. Simply put, MACRA’s goal is to put quality ahead of quantity. MACRA strives to incentivize healthcare practitioners and hospitals to support healthier patients – versus just processing high volumes of patient services. To achieve this, MACRA created two different payment tracks for Medicare Part B, namely the Merit-based Incentive Payment System (MIPS) track and the Advanced Alternative Payment Model (AAPM) track. In order to receive Medicare payments, providers must participate in one of these models.
MIPS calculates payments based on four weighted performance categories. Each of these contributes to an overall score. Quality currently accounts for the largest percentage (and replaces PQRS). Promoting Interoperability accounts for 25 percent (and replaces the EHR Incentive Program). Improvement Activities accounts for 15 percent. Cost accounts for the remaining percentage, adding up to a total of 100 percent.
The AAPM model, on the other hand, basically allows eligible providers to be exempt from participation in MIPS, and receive a five percent incentive payment. But it carries more financial risk than the MIPS track. That’s because CMS requires AAPM practices to have a vested financial interest in the cost and quality of the services they provide.
How MACRA and its two tracks work is fully explained in the five helpful online resources listed below. They also provide many answers to the most commonly asked questions.
- Centers for Medicare and Medicaid Services
- American Medical Association
- American Academy of Family Physicians
- S. Department of Health and Human Resources
- University of North Carolina Health Sciences Library
People often ask if MACRA was created as part of the Affordable Care Act (ACA), but it is not part of ACA. Instead, MACRA was separately established by the Centers for Medicare and Medicaid Services (CMS). Congress voted it into law through a bipartisan piece of federal healthcare legislation.
2019 Payments are Based on 2017 Performance
Because the payments are guided by annual performance, it’s not possible to calculate payments for 2019 during the current 2019 year. Neither is it practical to base those payments on 2018 performance, since it can take time and effort to generate, analyze, and calculate those performance metrics. That is why performance metrics from the year 2017 are being used to calculate this year’s payments. But practices can help themselves get ahead of the curve in terms of the big task of documentation and reporting by transitioning to technology that makes it easier. There are advanced software tools and platforms, for example, that reduce paperwork and labor to make it possible to generate HIPAA-compliant MACRA-related data faster, easier, and more error free.