Medicare & Medicaid

Making sense of MACRA: A glossary of new Medicare terms

Timothy M. Smith , Contributing News Writer

As John Harvey, MD, past president of the Medical Association of Georgia, has toured his state to discuss the upcoming Medicare payment transition, he has noticed a trend. “More than half the physicians I have talked to … were not aware of the terms MACRA, MIPS and APMs.” Of course, there are also QPP, ACI and numerous non-initialisms that refer to crucial elements of the law that repeals the sustainable growth rate. Following is a short list of the terms every physician should know before the new payment rules take effect Jan. 1.

Dr. Harvey, a general surgeon, was one of about 100 physicians to attend a recent MACRA educational session in Atlanta that was hosted by the AMA, the Medical Association of Atlanta, the Cobb County Medical Society and the DeKalb Medical Society. Another 100-plus viewed the presentation through a livestreamed webcast.  The session provided an overview of the new payment program, compared it with its predecessor, offered a timeline for the program’s implementation and delivered in-depth looks at the four participation options available in its transition year.

Before choosing a participation option, however, physicians will need definitions of the key elements of the program, beginning with the law itself:

MACRA: Short for the Medicare Access and CHIP Reauthorization Act of 2015. This is the law passed to reform the Medicare payment system. It repealed the sustainable growth rate formula, which calculated payment cuts for physicians. It also created a new framework for rewarding physicians who provide higher-value care.

QPP: The Quality Payment Program. This is that new payment framework. It offers two tracks for payment: MIPS and APMs, both discussed below.

MIPS: The Merit-based Incentive Payment System. MIPS aims to align three currently independent programs—quality reporting (what physicians know now as PQRS), Advancing Care Information (now known as EHR Meaningful Use), and cost (now known as the value-based modifier)—and adds a fourth component, Improvement Activities, designed to promote practice improvement and innovation. Some physicians will be exempt from MIPS through the low-volume threshold, defined below.

APMs: Alternative payment models. Few physicians will choose this track, as many APMs are not yet available in all states. APMs typically have shared savings, flexible payment bundles and other desirable features. There are two APM participation classifications—Advanced APMs, which have their own reporting requirements and are exempt from MIPS reporting, and MIPS APMs. Read more about APMs.

Pick your pace: This refers to the four participation options available in the transition year, which starts Jan. 1. Physicians may elect for MIPS testing, partial MIPS reporting, full MIPS reporting or Advanced APM participation. Read more about the four options.

Low-volume threshold: Physicians with less than $30,000 in annual Medicare revenue or fewer than 100 Part B-enrolled Medicare beneficiaries will be exempt from all MIPS reporting. Read more about accommodations for small practices.

PI: Promoting Interoperability. This replaces Meaningful Use. It features more reasonable reporting features, including base and performance scoring, fewer measures and 90-day reporting periods. 

Improvement activities: This new component, a feature of MIPS, is intended to provide credit for practice innovations that improve access and quality of care. It features more than 90 activities across eight categories. These too make accommodations for small practices.

Reporting option: Physicians will need to decide whether to report as an individual or as part of a group. A group is defined as two or more eligible clinicians. A physician in a group may choose to participate as an individual under MIPS.

Note: Except for those who qualify for the low-volume threshold, physicians who do not report any performance data in 2017 will be subject to a -4 percent payment adjustment when the new adjustments take effect, in 2019. Those who engage in partial or full reporting may be eligible for positive payment adjustments.

“We who are a little familiar with it know all the acronyms,” said Dr. Harvey, director of the transitional year residency program at Gwinnett Medical Center, in suburban Atlanta. “But if you go out and tell people, ‘Well, you just need to be compliant with MACRA, MIPS and APMs—you know, that’s the whole QPP process that we now have through CMS,’ they’ll say, ‘Oookay, well, I got that.’ [Instead] we need to explain this is truly what most physicians have done for many years. You look for better ways to provide cost-efficient care for patients. And get credit for it. Tell them that and they’ll say, ‘I try to do that all the time.’”

Get ahead on QPP

The AMA provides numerous resources for staying current on MACRA generally and the QPP specifically. Its Understanding Medicare Reform website features a collection of educational resources and tools that are continually updated as the AMA learns more about the questions physicians have regarding the transition. It also features a list of MACRA acronyms.