Defining MACRA and MIPS

Medicare Access and CHIP Reauthorization Act (MACRA) is a newly introduced replacement for the current Medicare reimbursement schedule. This pay-for-performance program focuses on quality, value, and accountability. Regulated by Centers for Medicare and Medicaid Services (CMS), MACRA lays out a new payment framework that seeks to rewards health care providers for giving better wholesome care instead of mere services. CMS had adjusted flexibility for the first year of participation in MACRA. It has also committed $100 million over five years to help smaller practices cope with MACRA changes. CMS also announced recently that it would delay expansion of bundled payment initiatives.

The act brings together parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program under one single acronym called the MIPS or Merit-based Incentive Payment System. This program will determine Medicare payment adjustments. Under this payment system the eligible professionals are set to receive payment bonuses, penalties or even no-adjustments through a composite performance score. This score counts in the quality of care, resources uses, clinical practice improvement activities put in place and meaningful use of certified electronic health records (EHR) technology. MIPS will annually measure eligible providers keeping a check on four performance categories to derive a score on a scale of 0 to 100.

MACRA & Political Scenario

Shift of power from hands of President Obama to President Trump has blurred the air that surrounds the healthcare stream in the federal nation. Although MACRA was passed with bipartisan support, members of the Trump administration have mostly remained mostly silent on the topics like value-based care or MACRA. This makes it difficult to gauge as to how stringently the new government would carry out the execution of provisions enlisted in MACRA.

Are Physicians & Healthcare Professionals Ready for MACRA?

" In a recent survey published by Healthcare Informatics, 43% said they need help with MACRA preparation, 30% said they are not at all prepared while 27% said they are ready to go. Only 13% of respondents said they participate solely in value-based payment models and 35% said they participate in both fee-for-service and value-based models while 52% said they participate solely in fee-for-service models."

Amidst the hustle to attain a clear understanding of MACRA, only 19% doctors said they were outright unprepared for MIPS reporting requirements as opposed with 47% who said they somewhat prepared. Even healthcare IT professionals and C-suite executives interviewed at are projecting concern over MACRA preparation. They are of the opinion that MACRA will end up being delayed due to its size and enormous financial impact on physician reimbursement.

What Does MACRA Require of A Physician?

Experts are of the view that the best way to get ready for MACRA and MIPS is to satisfy Meaningful Use Stage 2 requirements. Additionally they need to work towards achieving Physician Quality Reporting System requirements.


Thus, we can conclude that most practices are in haze about the requirements of the Quality Payment Program. Most practitioners are unsatisfied with time required to file reports. They are facing challenges of understanding detailed requirements and are uncertain around how MIPS performance is scored. The financial cost of capturing and reporting quality measures is also an issue of prime concern for doctors.

It is imperative that providers gain a clear grasp over the provisions of MACRA. This will help them develop a roadmap for adjusting their workflows and acquiring the tools and resources they will need. Over the coming years, payment models introduced by MACRA now will reduce the risks and increase the rewards associated to reimbursement.

Published By - Medical Billers and Coders
Published Date - Aug-01-2017 Back

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