The basics of MACRA/MIPS

Screen Shot 2016-08-18 at 9.37.52 PM
What is MACRA?

President Obama signed into law the Medicare Access and CHIP Reauthorization Act (MACRA) on April 16, 2015. It passed with a 392 to 37 vote in the House of Representatives, and a 92 to 8 vote in the Senate. That bipartisanship indicates the legislative support for MACRA and the significance of the bill in U.S. healthcare reform.

MACRA replaces the current Medicare reimbursement schedule with a new pay-for-performance program that’s focused on quality, value, and accountability. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework that rewards health care providers for giving better care instead of more service.

MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier(VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.

What is MIPS?

The Merit-Based Incentive Payment System (MIPS) is the name of a new program that will determine Medicare payment adjustments. Using a composite performance score, eligible professionals (EPs) may receive a payment bonus, a payment penalty, or no payment adjustment.

The Composite Performance Score is based on four performance categories:

  • Quality
  • Resource use
  • Clinical practice improvement activities
  • Meaningful use of certified electronic health records (EHR) technology

Performance for MIPS will start on January 1, 2017 and will annually measure eligible providers in four performance categories to derive a “MIPS score” (0 to 100). The MIPS score can significantly impact a provider’s Medicare reimbursement in each payment year from -9% to +27% by 2022. The four performance categories are weighted:

  • 50% for quality (PQRS/VBM)
  • 25% for Meaningful Use
  • 15% for clinical practice improvement
  • 10% for resource use

The points provided for each category will shift over time to place an increasing focus on more resource use.

What should I be doing now to get ready?

The best way to get ready for MACRA and MIPS is to satisfy Meaningful Use Stage 2 requirements and continue to work on achieving PQRS requirements. CMS has stated that providers already attesting to Meaningful Use and PQRS will likely have no net new requirements.

The MIPS proposed rule is expected in the summer of 2016 and the final rule is expected in November. The final rule will determine how points are earned within each component.

Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload the CAPTCHA.