In April 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015, simply called MACRA. Unlike the Affordable Care Act (“ObamaCare”), the MACRA bill had rare, overwhelming bipartisan support, with a final vote of 392-37 in the House and 92-8 in the Senate. Shortly after the signing, the Centers for Medicare and Medicaid Services released the proposed rule implementing the legislation. The public comment period has recently ended and the final rule is expected this fall.
MACRA provides a catalyst for the Department of Health and Human Services (HHS) to realize its goal of moving from paying for health care based primarily on fee-for-service to primarily fee-for-value. Early in 2015, HHS set a goal that 30% of Medicare payments would be linked to alternative payment models by the end of 2016, and 50% by the end of 2018. A second goal was that 85% of fee-for-service payments would be tied to quality or value by the end of 2016, and 90% by the end of 2018.
MACRA provides two pathways for clinician payment based on value and quality: the Merit-Based Incentive Payment System (MIPS) and certain Advanced Alternative Payment Models (Advanced APMs). Most clinicians will fall under MIPS, which adjusts payments up or down according to a quality report system that incorporates multiple previous quality programs under Medicare, including the Meaningful Use incentives for electronic medical records and the Physician Quality Reporting Program (PQRS). MIPS will generate a weighted score across four performance categories that will be used to adjust payments up or down in an overall budget-neutral way. Those categories and their initial weights are: