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Understanding Medicare Payment Reform (MACRA)

Following years of advocacy by the nation's physicians standing up for their patients and their practices, Congress repealed the sustainable growth rate (SGR) formula.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

While the bill supports physicians who choose to adopt new payment and delivery models, it also retains a fee-for-service model. Under this model MACRA consolidates former reporting programs and offers greater flexibility for physicians.

The AMA is committed to informing and supporting physicians and their practices during these complex changes. Change will not and should not occur overnight. It will be a long-term transition. From research to education, and advocacy to practice management tools, the AMA will provide the key resources physicians need to succeed in the coming years.

Read the proposed rule issued April 27, 2016 by the Centers of Medicare & Medicaid Services (CMS). In the coming weeks, the AMA will develop a detailed analysis of the proposed rule and coordinate formal written comments with state and national medical societies. The deadline for comments is 5 p.m. on June 27, 2016.

Physician Choices

Physicians can choose between 2 different pathways of payment models—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 and 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 Systems: 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.

Preparing Your Practice for Value-Based Care

The online module will help you make the shift to value-based care and benefit both your practice and your patients.

Read more about how to prepare for Medicare’s new payment systems.

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

Read more about AMA’s efforts to help physicians by improving Medicare payment reform.

Additional Resources

MACRA Frequently Asked Questions and Myth/Fact Clarifications

MACRA Bill Summary

MACRA Comparison vs Prior Law

2016 Physician Payment Schedule

Summary of the 2016 Medicare Physician Fee Schedule Final Rule

2016 Medicare Physician Fee Schedule Comment Letter, Sept. 8, 2015

2016 Medicare Hospital Outpatien Prospective Payment System and Ambulatory Surgical Center (OPPS/ASC) Comment Letter, Aug. 31, 2015