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HHS Finalizes MACRA Rule, Continues Shift to Value-Based Care in Medicare


HHS has finalized the landmark Medicare Access and CHIP Reauthorization Act (MACRA), which reforms payment for Medicare providers and replaced the sustainable growth rate formula.

HHS has finalized the landmark Medicare Access and CHIP Reauthorization Act (MACRA), which reforms payment for Medicare providers and replaced the sustainable growth rate formula.

The new payment system builds on the administration’s focus to deliver better care with Medicare paying for quality, and clinicians providing patient-centered care.

“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care,” Andy Slavitt, acting administrator of CMS, said in a statement. “To be successful, we must put patients and clinicians at the center of the Quality Payment Program.”

The final rule is nearly 2400 pages long and the result of nearly 4000 public comments. During the months-long listening tour, HHS commonly heard requests for flexibility, simplicity, and better support for small practices.

“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” said HHS Secretary Sylvia M. Burwell. “Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”

Under MACRA, providers will have the opportunity to dictate the pace at which they want to transition from fee for service to value-based care by choosing either advanced alternative payment models (APMs) or the Merit-based Incentive Payment System (MIPS).

Under the Advanced APMs path, clinicians will receive a 5% incentive payment in 2019 if they receive 25% of Medicare payments or see 20% of Medicare patients through an Advanced APM in 2017.

Under MIPS, there are 3 options:

  1. Don’t participate by not sending in any 2017 data and receive a negative 4% payment adjustment.
  2. Submit something and avoid a downward payment adjustment.
  3. Submit 90 days of 2017 data and earn a neutral or small positive payment adjustment.
  4. Submit a full year of 2017 data and earn a moderate positive payment adjustment.

“A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose,” Slavitt said. “Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures.”

Kate Goodrich, MD, director of the Quality Measurement and Value-Based Incentives Group in CMS, anticipates that the changes could be challenging for some clinicians.

“I think the initial first challenge for clinicians is really understanding what all of this means,” she said in an interview with The American Journal of Managed Care from May. However, CMS has been partnering with professional organizations, patient organizations, registries, and more to ensure clinicians understand what is expected of them.

“So, while some of it may seem uncertain, a little bit scary, people are not quite sure what it is they have to do yet, there is quite a bit of help on the way, much of it coming from CMS and moneys we’re giving through contracts and other arrangements for front-line, boots on the ground assistance to providers to help them,” Goodrich said.

MACRA will support small practices by providing $20 million each year for 5 years to train and educate Medicare clinicians in practices with 15 or fewer clinicians and those who work in underserved areas.

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