The Centers for Medicare and Medicaid Services (“CMS”) recently issued a final rule establishing key guidelines for the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Congress enacted MACRA to replace the inefficient Medicare Sustainable Growth Rate framework because its rate schedules yielded regular fee declines and required frequent legislative adjustments to remedy.
MACRA includes two reforms that change how physicians receive pay. First, MACRA increases physician fees by 0.5 percent per year from 2016 to 2019. Second, MACRA creates the Quality Payment Program, a payment model beginning in January 1, 2019 that emphasizes compensating clinicians based on the value of care received by patients, rather than the volume of services provided by physicians. The Quality Payment Program includes two paths: 1) the Merit-based Incentive Payment System (“MIPS”) and 2) the Advanced Alterative Payment Models (“Advanced APMs”). This article discusses each.
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