In April 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, permanently repealing an outdated, 18-year-old formula for reimbursing providers under Medicare.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More specifically, MACRA is bipartisan legislation that repealed the sustainable growth rate formula and also changes the way that Medicare rewards healthcare professionals for value over volume. MACRA established a new payment system called the Quality Payment Program (QPP) with two pathways for linking payment to quality and value. The 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.
Year 3 of the program began January 1, 2019. In November 2018, the Centers for Medicare and Medicaid Services (CMS) released the final rule outlining the parameters for MIPS and Advanced APMs under the QPP for Year 3. We will continue to update the toolkit with resources as CMS releases further guidance.
- CMS has posted an executive summary and fact sheet highlighting key points of the final rule for QPP Year 3.
- CMS' full QPP resource library can be accessed here.
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
Understanding the 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 factors in four weighted performance categories: Quality, Promoting Interoperability (formerly Advancing Care Information), Improvement Activities, and Cost. Performance in these categories is combined into one score called the MIPS Composite Performance Score (CPS) on a 0-100 point scale. The CPS is 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.
- Check out this quick start guide to MIPS participation for 2019
- Learn more about MIPS scoring for the 2018 performance period
- Take these steps to get ready for reporting
More on the MIPS Performance Categories (percentages listed are for 2017):
- Quality (45%): Replaces the Physician Quality Reporting System (PQRS). Clinicians report up to six measures. Unlike PQRS, which was a pay-for-reporting system, clinicians’ performance on these measures are evaluated based on benchmarks.
- Promoting Interoperability (25%): Replaces 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%): 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 select up to four activities to receive a maximum score in this category.
- Cost (15%): Replaces the "Value-Based Modifier" and evaluates clinicians on relevant cost measures. This category began counting towards a clinician's CPS in 2018.
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:
- 2018 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.
MACRA News from AGS
- Letter to CMS on CY 2019 Physician Fee Schedule and Quality Payment Program Proposed Rule (September 10, 2018)
- Letter to CMS on New MIPS Specialty Measure Set for Geriatrics (February 9, 2018)
- Comments to CMS on CY 2018 MACRA Proposed Rule (August 2017)
- Comments to Acumen, LLC on MACRA Episode-Based Cost Measures (April 2017)
- Article: Medicare Access and CHIP Reauthorization Act: What do Geriatrics Healthcare Professionals Need to Know about the Quality Payment Program? (March 2017)
- Comments to CMS on Patient Relationship Categories & Codes (January 2017)
- Comments to CMS on MACRA Final Rule (December 2016)
- Comments to CMS on Proposed Rule to Implement MACRA (June 2016)
- Comments to CMS on Episode Groups RFI (March 2016)
- Comments to CMS on Implementation of MACRA RFI (November 2015)
- Plenary Presentation at the May 2016 Annual Scientific Meeting – Overview of Law and Proposed Regulations
MACRA Tools from Other Organizations
- Council of Medical Specialty Societies & Osmosis (Physician Compensation in the U.S.: A Video Overview)
- 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.