Quality & MIPS Resources

Medical Access & CHIP Reauthorization Act (MACRA)

Quality Payment Program

The Medical Access & CHIP Reauthorization Act (MACRA) was passed to reform the Medicare payment system and replace the Sustainable Growth Rate with a more predictable formula. It provides opportunities for physicians who constantly provide higher-value care to be rewarded through the Quality-Payment-Program (QPP). Depending on eligibility, payment impact, and other factors under QPP, there are two payment threads to choose from, Merit Based Incentives (MIPS) and Alternate Payment Methods (APM). The implementation of MACRA will have an impact on the physicians, hospitals and care systems who provide quality care for Medicare patients.

Merit-Based Incentive

Alternate Payment Methods

Who is Eligible:

Default QPP for physicians unless you have a low volume of Medicare patients or participants in Advanced APMs

An alternative option to MIPS for physicians with significant participation in more advanced levels of value-based activities

How is Payment Impacted:

There is a sliding scale of rewards and penalties starting at 4% in 2019

Advanced APM entities will receive a 5% Medicare Part B incentive payment from 2019 – 2024

How are Physicians Evaluated:

Four ways of evaluating
– Quality reporting
– Advancing Care Information
– Cost (value-based modifier)
– Improvement activities

Advanced APMs have their own reporting requirements and are exempt from MIPS reporting. MIPS APMs fall under MIPS reporting system

For Further Education

AVLS PRO Venous Registry Participation
Under MACRA, the payment component for quality represents 60%. The AVLS PRO Venous Registry is a CMS recognized specialty registry, which qualifies for the maximum quality payment component of 60% as long as you are reporting on six clinical quality measures. If you are using an EHR that is ONC HIT certified, you should already be capturing six or more clinical quality measures. For more information on the AVLS PRO Venous Registry and how to participate, please click here.

FAQ on MACRA and Payment reforms
Frequently asked questions on MACRA. It covers everything from small practices to Pick Your Pace in an easy to use format.

Glossary of Terms
A short, but comprehensive explanation of MACRA terms physicians should know.

MACRA & QPP Final Rule
A seven page document outlining AMA’s final ruling on the QPP.

MACRA Timeline
A graphic image outlining MACRA’s bonuses or penalties in both QPP programs.

Medicare Alternative Payment Models
A 5-step process to effectively create APM proposals that work and can be implemented under the new law.

MIPS Overview
A tool provided by CMS to browse the different MIPS measures and activities.

Summary of MACRA & QPP Final Ruling
A snapshot of five take-aways from MACRA’s final ruling on how to succeed in the first year of implementation.

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