CMS Reveals MACRA Rules

Join Our Mailing List

A CMS … Proposal

[By Andy Salmen]

The Centers for Medicaid and Medicare Services (CMS) have finally released the much anticipated unveiling of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) rule proposal.

The goal of this rule is to establish key parameters for the new Quality Payment Program, a framework that includes the Merit-based Incentive Payment System (MIPS) and Alternative Payment Models (APMs). These two paths for compliance allow doctors more flexibility in achieving compliance.


MIPS scores clinicians based measures and activities chosen by physicians and is based on their specialty. MIPS would basically streamline and combine three of the different programs that currently exist under Medicare. These programs are Physician Quality Reporting System, the Value-Based Modifier Program, and the ‘Meaningful Use’ of electronic health records.

There will be four performance categories for clinicians (clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, certified registered nurse anesthetists, etc.) to be scored on. These performance categories are:

  • Quality
  • Advanced Care Information
  • Clinical Practice Improvement Activities
  • Cost


CMS proposed implementing an Advanced Payment Models (APM) pathway, allowing eligible clinicians to become “qualified participants”. This means that eligible clinicians will be able to earn statutorily specified incentives for participation.

CMS predicts most providers to initially opt for MIPS. It is expected that participation in APMs, both number of physicians and number of payment models, will grow over time, as this program will qualify clinicians for financial bonuses in exchange for taking the risks associated with providing “coordinated, high-quality care”, according to CMS. 





Your thoughts and comments on this ME-P are appreciated. Feel free to review our top-left column, and top-right sidebar materials, links, URLs and related websites, too. Then, subscribe to the ME-P. It is fast, free and secure.

Speaker: If you need a moderator or speaker for an upcoming event, Dr. David E. Marcinko; MBA – Publisher-in-Chief of the Medical Executive-Post – is available for seminar or speaking engagements. Contact:


Product Details



5 Responses

  1. MACRA doesn’t spell end of independent practices

    While the Medicare payment reform law Congress passed last year poses numerous challenges for independent medical practices, it will not doom them.



  2. COUNTER-POINT: Medical Industry Concerned MACRA Could Endanger Small, Solo Practices

    There is growing concern that the Medicare Access and CHIP Reauthorization Act (MACRA), which will change how Medicare reimburses physicians, “will sharply increase the financial pressures that physicians in rural, solo and small practices face.” A recent study published in the journal Health Affairs calculated the current scope of that data collection and reporting, as required by Medicare, private insurers, and others. The total: $40,000 per doctor per year, or $15.4 billion nationally.

    Tim Gronniger, deputy chief of staff at CMS, acknowledged that MACRA is bringing significant change, but he insisted that “the current way we pay doctors incentivizes them in bad ways – to waste resources, for example.” Gronniger said CMS has already scaled back the number of physician measures as part of the new law. Even so, the AMA and other physician groups are pushing to delay the start date from next January until at least July. “This is all very complex,” said Andrew Gurman, president of the AMA. “But we are committed to trying to make the new law work.”

    Source: Steven Findlay, Kaiser Health News [8/23/16]


  3. MACRA ‘Escape Clause’ Lets Docs Exclude Satisfaction Ratings in Determining Pay

    Most physicians have long been critical of patient satisfaction surveys. They question whether the surveys truly measure quality and whether it’s fair to use them to determine physician bonuses. They will finally get their wish under the new physician payment system under the Medicare Access & CHIP Reauthorization Act. The 90% of physicians expected to use the standard incentive program (dubbed MIPS for Merit-based Incentive Payment System) will have the option of excluding patient satisfaction ratings from the formula for determining rewards or penalties to their pay.

    The CMS escape clause came in response to the general hostility most physicians have toward the surveys. In a survey for Modern Healthcare conducted by New York City-based SERMO, an online physicians’ social networking website with over 600,000 members around the world, only 9% of 2,100 respondents thought patient satisfaction surveys accurately reflect the quality of care.

    Source: Howard Wolinsky, Modern Healthcare [9/3/16]


  4. Pranjali Joshi: Nine things healthcare executives should know about MACRA

    1. Participants can choose one of two program tracks: the Advanced Alternative Payment Models (APM) or Merit-Based Incentive Payment System (MIPS).
    2. MIPS combines three established payment programs.
    3. The APMs track provides additional incentives to participation.
    4. MACRA affects all providers beginning in 2017, including those with small and solo practices.
    5. CMS has made 2017 a transition year.
    6. CMS has adjusted the weighting for the performance-based scoring categories for 2017.
    7. Providers need to take steps to avoid negative payment adjustments.
    8. Providers have good incentives to start preparing right away.
    9. Technology plays a key role.

    Source: Managed Healthcare Executive


  5. MACRA Questions?

    Yes – The Medicare Access and CHIP Reauthorization Act (MACRA) makes significant changes to the Medicare payment system by introducing a quality-based payment model. MACRA changes how providers caring for Original Medicare members are reimbursed and includes incentives for risk-based payments by all types of payers.

    While MACRA primarily affects Part B clinicians, there are numerous implications, synergies, and opportunities for Medicare Advantage (MA) plans.

    But, the key questions for Medicare Advantage plans to consider include: How will MACRA affect MA plans’ provider payments? What synergies exist between MACRA’s quality scoring and the MA Stars quality program? How can MA plans help providers achieve Qualifying Participant (QP) status? What incentives exist under MACRA for providers to improve risk score coding? How are MA plans in the market responding to MACRA?

    Your thoughts, and answers, are appreciated.

    Dr. David Edward Marcinko MBA


Leave a Reply

Please log in using one of these methods to post your comment: Logo

You are commenting using your account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s

%d bloggers like this: