Medicare Payment Reform

Prepare for changes happening through the Medicare Access & CHIP Reauthorization Act (MACRA).

Understanding Medicare Payment Reform (MACRA)

The proposed rule was issued on April 27, 2016 by the Centers for Medicare & Medicaid Services (CMS). AMA staff is continuing a rigorous review of the proposed rule and will provide detailed comments to CMS by the June 27 deadline. AMA staff submitted the following sign-on letter to CMS on June 24, 2016: MIPS/APM Incentive Under Physician Fee Schedule, and Criteria for Physician-Focused Payment Models; Proposed Rule.

AMA 2016 Annual Meeting Update

Start preparing for the transition to MACRA. Download an action kit and a slideshow to learn more about what is in the proposed rule and share preparation tips with colleagues.

Download the Action Kit Download the Slideshow

Andy Slavitt, CMS Acting Administrator, presented comments before the American Medical Association 2016 Annual Meeting Chicago, IL. Read the speech or watch the video.

MACRA Stabilizes Medicare Physician Pay

Following years of advocacy by the nation's physicians standing up for their patients and their practices, Congress repealed the sustainable growth rate (SGR) formula. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) permanently eliminates SGR (and its annual threat of physician payment cuts) and provides positive annual payment updates lasting through 2019.

From research to education, and advocacy to practice management tools, the AMA is providing the key resources physicians need to succeed through this long-term transition.

Two Payment Pathways for Physicians

Consistent with the law, the proposed rule creates 2 different payment pathways for physicians—alternative payment models (APMs) and the Merit-Based Incentive Payment System (MIPS).

Alternative Payment Models: MACRA supports physicians who choose to adopt new payment and delivery models approved by the Centers for Medicare & Medicaid Services. Participation in these new models is entirely voluntary. Physicians who choose to be paid under eligible APMs are exempt from participating in MIPS.

Merit-Based Incentive Payment System: MACRA also retains a modified fee-for-service model and consolidates former reporting programs (Physician Quality Reporting System, Value-Based Modifier, Meaningful Use) to provide greater flexibility. Initially, most physicians are expected to be participants in MIPS.

Preparing Your Practice for Value-Based Care

View our AMA STEPS Forward™: Practice Transformation Series learning module.

Visit the Module

Medicare Payment Reform News

Payment model design needs to be physician-led: New report 6/14/2016

Physicians passed policy to ensure new payment models are physician-led to allow for the resources and flexibility needed to implement solutions for improving care for patients, rather than letting regulators dictate the way care should be delivered.

Physicians are guiding new payment system, CMS chief says 6/13/2016

Centers for Medicare & Medicaid Services Acting Administrator Andy Slavitt said the driving factor in the Medicare payment system redesign was physician input—and the proposed rule attempts to reflect that. But the physician's role does not stop there.

How new Medicare payment system intends to help small practices 5/20/2016

Recent draft regulations outline sweeping changes to the Medicare payment system, and one of those eagerly anticipated changes is the Centers for Medicare & Medicaid Services' stated intent to ease physicians' administrative burdens.

Read more news on AMA Wire® >

Physician Payment and Delivery Models

Read more about tools and resources for assessing and choosing payment models.

View Tools and Resources