The Medicare Access and CHIP Reauthorization Act (MACRA) was passed by Congress and signed into law in 2015. This historic bipartisan legislation substantially supports the much-needed transition from the current volume-driven, fee-for-service (FFS) reimbursement model, to a value-based system that rewards quality and value of care over volume of services provided. MACRA included several provisions, some of which include:
On April 27, 2016, the Centers for Medicare and Medicaid Services (CMS) announced a proposed rule (summarized in this news release), which outlines how CMS proposes to implement the law, including details regarding MIPS and APMs. This proposed rule provides an opportunity to help shape the details of the law's implementation, and the PCPCC will respond before the June 27 deadline with strong comments to support advanced primary care. (Note: PCPCC's comments will be published on our advocacy webpage once submitted to CMS.)
Although the major provisions of MACRA begin in 2019, providers should prepare now because Medicare will use 2017 performance data for payment in 2019.
The U.S. Department of Health and Human Services offers an easy-to-understand video to help explain the complex regulation that is MACRA:
The MACRA makes three important changes to how Medicare pays those who provide care to Medicare beneficiaries:
These changes create a Quality Payment Program (QPP).
On June 27, 2016, the PCPCC submitted its official comments to CMS on the MACRA proposed rule, which are summarized in a June 28 press release.
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Eager to Learn More?
Listen to Washington DC-based health care policy analyst and researcher David Introcaso's Healthcare Policy Podcast, "How CMS Proposed to Annually Update Medicare Physician Reimbursement Under MACRA: A Conversation with Mara McDermott."
Title | Source | Date |
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Does MACRA leave small physician practices behind? | Modern Healthcare | August 23, 2017 |
Docs, Nurses Press for Changes to MACRA Rule | MedPage Today | June 27, 2016 |
Could Medicare’s New Doctor Payment System Endanger Small and Rural Practices? | Washington Post | August 23, 2016 |
Coalition Letter on Improving Transparency for Innovation Center Models | March 26, 2019 | |
CMS’ Payment Reg: Promising Policies, but Tied to a Flawed System:Better Health – NOW Campaign to Submit Comment | July 21, 2022 | |
CMS Unleashes Bigger Trove of Claims Data to Help Hospitals Improve Care Quality | Healthcare IT News | July 5, 2016 |
CMS Touts Savings, Quality Under Primary-Care Initiative | Modern Healthcare | October 17, 2016 |
CMS Solicits Advice on New Medicare Payment Rules | Medscape | July 10, 2015 |
CMS Seeks to Ease MACRA Rollout by Reducing Physicians' Administrative Burdens | Modern Healthcare | October 13, 2016 |
CMS Proposes Quality Payment Program updates to increase flexibility and reduce burdens | CMS | June 20, 2017 |