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 submitted the following letters on 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. Immediately following his address to physician delegates, Slavitt sat down with Matt Burnholz, MD, of ReachMD for a podcast to discuss why it is important for CMS to take an "outside-in" approach of listening to physicians as they finalize and implement MACRA. Listen to the full interview from ReachMD.

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Following years of advocacy by the nation's physicians standing up for their patients and their practices, Congress repealed the sustainable growth rate (SGR) formula.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.

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Medicare Payment Reform News

New Model Makes Patient Care More Than Face-to-Face Visits 7/29/2016

Two things that physicians want for their patients are more stability and fewer visits to the emergency department. But often the services that are needed to do so are unbillable, and the resources are hard to find otherwise.

Tracking Patients Between Visits: A New Care Model 7/19/2016

As the health care system transitions to value-based care, new models of care will be a critical part of the new Medicare payment system. Learn how one physician is using a new model of care to track patients in between face-to-face visits in his practice.

Later Start Date Could Ease Transition to New Medicare System 7/18/2016

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.

Read more news on AMA Wire® >

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Physician Payment and Delivery Models

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

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