What is MACRA?
MACRA makes three important changes to how Medicare pays physicians who provide care to Medicare beneficiaries. These changes include:
- Repealing the sustainable growth rate (SGR) formula for determining Medicare payments for healthcare providers’ services
- Creating a new framework for rewarding healthcare providers for giving better care
- Combining existing quality reporting programs into one new system.
The difference between top and bottom performing hospitals may be an increase or decrease of $4 million in Medicare Part B revenue.
The program includes two new Quality Payment Programs, the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs), both of which go into effect over a timeline that started in 2015 and goes through 2021 and beyond.
Physician Medicare payments will now be determined using a composite score based on quality, resource use, meaningful use and clinical practice improvement measures with the opportunity to receive significant incremental reimbursement for positive scores.