Discover how the Medicare Access and CHIP Reauthorization Act of 2015 ("MACRA") led the Centers for Medicare and Medicaid Services (CMS) to create a new quality payment program that is transforming how providers are paid.
MACRA is a separate piece of legislation from the Affordable Care Act (ACA), also known as Obamacare. Unlike the ACA, MACRA passed with wide bipartisan support. Although some components of these laws are intertwined, major changes to the ACA under the new administration will not eliminate MACRA.
Learn More About MIPS
What did MACRA do?
- Permanently repealed the sustainable growth rate (SGR) methodology for determining payment updates to the Medicare physician fee schedule
- Stabilized physician payments with 0.5% positive updates annually from 2015 through 2019
- Created a new quality payment program under which physician payments will be based on participation in one of two pathways: Merit-based Incentive Payment System (MIPS) or Alternative Payment Models (APMs)
- Latest Updates
- CMS announces final rule implementing MACRA. Read the AAN's summary of the final rule. (October 14, 2016)
- CMS has acknowledged the many challenges facing physician practices to implement MACRA and released a plan to allow physicians to pick their pace of participation in the first performance period that began on January 1, 2017.
- CMS announces its proposal to implement the MACRA law. Learn more about the proposal. Read the AAN's comments to CMS in response to their proposal. (April 27, 2016)
- Merit-based Incentive Payment System (MIPS)
MIPS ties Medicare payments to performance by consolidating three existing Medicare incentive programs and adding one new component. MIPS will provide physician payment penalties or bonuses beginning in 2019 based on 2017 performance data.
Under MIPS, neurologists must be prepared to be measured on performance in:
- Alternative Payment Models (APM)
Alternative Payment Models (APMs) move providers even further from existing fee-for-service (FFS) payments towards true value-based payments (e.g., bundled payments, global payments). Several broad requirements exist for successful provider participation in APMs, with these requirements to be further clarified during future regulatory rule-making:
- Takes on "more than nominal" financial risk for attributed patients
- Reports on quality measures comparable to those under the MIPS program
- Uses a certified Electronic Health Record (EHR)
- Meets a threshold percentage, that increases over time, of payments that are linked to value through Medicare or all-payer APMs
Providers who successfully meet the APM criteria will receive a 5-percent annual lump sum bonus every year from 2019 to 2024 and are exempt from the MIPS program.
- AAN Tools & Resources
- Read Articles About MACRA
- AAN Lobbying Helps Ease Impact of MACRA Changes on Neurologists (AANnews® December 2016)
- MACRA and the Future of Value-based Care (Neurology® Clinical Practice, October 2016)
- MACRA APM: The Path Less Taken? Maybe Not (AANnews®, July 2016)
- 2014 PQRS Experience Report: Highlights for Neurologists (AANnews®, July 2016)
- CMS Announces Proposed MACRA Changes to Medicare Reimbursement (AANnews®, June 2016)
- AAN Creates Alternative Payment Models for Epilepsy, Headache/Migraine (AANnews®, April 2016)
- Five New(ish) Acronyms That Are Changing Physician Payment: How They Will Affect You (Neurology Today®, March 2016)
- Understand How MACRA Will Affect You (AANnews®, September 2015)
- What More Is Inside MACRA for Neurologists? (AANnews®, August 2015)
- Power Your Practice: SGR Fix Ushers in New Reforms (AANnews®, July 2015)
- Advocating for Neurology
- AAN's response to the CMS request for feedback on patient relationship categories and codes (July 1, 2016)
- AAN's response to CMS's proposed MACRA rule (June 23, 2016)
- AAN's sign-on letter about private sector APM activities (April 18, 2016)
- AAN's response to proposed quality measure development plan (February 17, 2016)
- AAN's response to the CMS request for feedback on care episode and patient condition groups (February 11, 2016)
- AAN's response to the request for information about MIPS and APMs (November 16, 2015)
- Non-AAN MACRA Resources