In April 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, permanently repealing an outdated, 18-year-old formula for reimbursing providers under Medicare. Year 1 of the program began in 2017.
More specifically, MACRA is bipartisan legislation that repealed the sustainable growth rate formula and also will change the way that Medicare rewards healthcare professionals for value over volume. Importantly, MACRA establishes two payment pathways for linking payment to quality and value. The new Merit-based Incentive Payments System (MIPS) allows clinicians to earn a positive payment adjustment by reporting in the following categories: quality, improvement activities, advancing care information (replaces Meaningful Use), and cost. Clinicians may also participate in Advanced Alternative Payment Models (APMs), where practices can earn more for taking on some risk related to their patients’ outcomes. MACRA itself reflects more than 10 years’ worth of advocacy by the AGS, its members, and a diverse cadre of other stakeholders committed to affecting change to improve the health and care of older adults.
In late 2016, the Centers for Medicare and Medicaid Services (CMS) released the final rule implementing MACRA. The rule finalizes parameters of the MIPS and the APMs which took effect January 1, 2017. In July 2017, CMS released a proposed rule that would make changes in the second year of the QPP as required by MACRA. We will continue to update the toolkit with resources once CMS finalizes these changes later this year.
- Education and tools from CMS on the final rule can be found here and below.
- CMS has also posted a fact sheet on Where to Find Help.
AGS MACRA Toolkit
The AGS has pulled together resources to help you navigate these changes.
What You Need to Know to Be Prepared for MACRA
In April 2015, legislation was signed into the law that permanently repealed an outdated, 18-year-old formula for reimbursing providers under Medicare. This milestone reflects more than 10 years' worth of advocacy by the AGS and a multitude of other stakeholders committed to improving care of older adults. This change will affect physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.
MIPS and Advanced APMs will go into effect over a period of time starting in 2017 and continues for years to follow. Reporting will start in 2017 and will affect payments starting in 2019. In 2017, CMS will allow clinicians to report measures and perform activities for a minimum of 90 continuous days – this means that clinicians may begin collecting data any time between January 1 and October 2. Here is a timeline of what to expect and when.
Understanding the New Quality Payment Program (QPP)
The QPP is a new payment approach, recognizing value and effectiveness of care provided by clinicians. The goal is to shift the payment system from quantity to quality, thus improving care for Medicare patients. This system includes two paths:
MIPS will factor in 4 weighted performance categories: Quality, Advancing Care Information, Improvement Activities and Cost. Performance in these categories will be combined into one score called the MIPS Composite Performance Score (CPS) on a 0-100 point scale. The CPS will be compared to a “Performance Threshold” and clinicians’ Medicare Part B payments will be adjusted up or down based on whether they are above or below the threshold.
- Learn more about MIPS Scoring Methodology & Overview.
- Getting started
More on the MIPS Performance Categories (percentages listed are for 2017):
- Quality (60%): This category will replace the Physician Quality Reporting System (PQRS). Generally, clinicians will select and report on 6 measures to be evaluated on. Unlike PQRS, which was a pay-for-reporting system, clinicians’ performance on these measures will be evaluated based on benchmarks.
- Advancing Care Information (ACI) (25%): This category will replace the previous Medicare Electronic Health Record (EHR) Incentive Program, "Meaningful Use." While there are certain mandatory measures, MIPS creates a more customizable experience for clinicians, allowing them to choose which additional measures to emphasize in their scoring.
- Improvement Activities (15%): In this new performance category, clinicians are rewarded for performing activities identified as improving clinical practice or care delivery, such as activities related to care coordination, patient engagement, and patient safety, that are likely to result in improved outcomes. Clinicians will select up to four activities to receive a maximum score in this category.
- Cost (0%): This category will replace the "Value-Based Modifier" and evaluate clinicians on relevant cost measures. This category will not require any data submission and will be calculated based on adjudicated claims. CMS will provide feedback on measure scores based on 2017 performance but those scores will not count toward the 2017 CPS. Beginning in 2018, the category will contribute to a clinician's CPS.
APMs are a new approach that incentivizes clinicians providing exceptionally high quality and value of care. Those who participate in the most advanced APMs may qualify as qualifying APM participants (QPs). QPs would be exempt from MIPS and qualify for 5% incentive payments.
More about APMs:
- Comprehensive List of APMs
- What is a MIPS APM and How to Participate
- About the Committee that Reviews Physician-Focused Payment Models
Support for small practices using MIPS or APMs
CMS has outlined some ways the new QPP can offer flexibility and support to small practices.
Webinars & Tools
MACRA News from AGS
- Comments to CMS on Patient Relationship Categories & Codes (January 2017)
- Comments to CMS on MACRA Final Rule (December 2016)
- Response to CMS Proposed Rule to Implement MACRA (June 2016)
- Response to CMS on Episode Groups to be used in MIPS (March 2016)
- Response to CMS RFI Regarding Implementation of MACRA (November 2015)
- Plenary Presentation at the May 2016 Annual Scientific Meeting – Overview of Law and Proposed Regulations
MACRA Tools from Other Organizations
- Centers for Medicare & Medicaid Services (A Quick Start Guide to the Merit-based Incentive Payment System, MIPS)
- American Medical Association
- American College of Physicians
- American Academy of Family Physicians
Questions on MACRA or Recommendations for Resources You’d Like to See –Contact firstname.lastname@example.org
2017 MIPS Quality Measures Relevant to Geriatrics
To help members participate in quality reporting under MIPS, a workgroup of the AGS Quality and Performance Measurement Committee reviewed the 300+ quality measures approved by CMS for reporting in 2017 and identified 10 quality measures that were 1) most likely to be relevant to geriatricians’ clinical practice and 2) most likely to be measures where geriatricians will perform well relative to other clinicians. Click here to read the workgroup’s recommendations and to learn more about important requirements and payment changes under MACRA. NOTE: These quality measures are suggestions based on the workgroup’s review. Individual clinicians or practices may find other measures better fit their practice. These measures are not part of an official CMS-designated Specialty Measure Set or developed or endorsed by the AGS.