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MACRA knowledge hub

Learn about the MACRA proposed rule, MIPS, and alternative payment models. Discover how you can be rewarded for providing better, lower-cost, patient-centered care while avoiding program penalties.


What is MACRA? 

MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015. The act was signed into law in early 2015 and makes substantial changes to the government’s health care payment system. The significant portions include permanently repealing the Sustainable Growth Rate (SGR) formula for determining provider payments and changing the Medicare physician fee schedule by establishing two new options for reimbursement: the Merit Based Incentive Payment System (MIPS) and Alternate Payment Models (APMs). 

What is the purpose of MACRA?

According to CMS, MACRA creates a new framework for rewarding providers for better, lower-cost, patient-centered care.  

CMS continues to promote the shift away from fee-for-service payments to adopting alternative payment models (APMs) to hit industry goals of having 50% of Medicare payments made through APMs, and having 90% of remaining fee-for-service payments tied to quality and value by the end of 2018.

What is the timeline for MACRA?

The first performance year started January 1, 2017 and will impact payments adjustments in 2019. Performance in 2018 will impact payments adjustments in 2020.

What providers are affected by MACRA?

MACRA, and the Quality Payment Programs that come out of it, will impact most providers across the country. You can check CMS's QPP website to see if you have to participate.

What are the two tracks for providers under MACRA?

MACRA has two main components.

  1. Merit-based Incentive Payment System (MIPS) – this is the next evolution of Meaningful Use (MU), the Physician Quality Reporting System (PQRS), and the Value-based Payment Modifier (VM) programs. It focuses on four threads of work, assigning providers a composite score based on their performance across all four threads that serves as a modifier on their Medicare Part B reimbursements.
  • Quality (formerly known as PQRS)
  • Cost
  • Improvement Activities (a new measure of care coordination, patient engagement and safety)
  • Advancing care information (formerly known as MU)
  1. APMs –Alternative Payment Models favor medical groups that adopt two-sided risk-based payment models. There are relatively few eligible APMs, but CMS plans to approve more models over time. The following models are among those that have made the initial cut. 
  • Next Generation ACO
  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings Program (MSSP) Tracks 2 and 3
  • Oncology Care Model with two-sided risk
  • Comprehensive ESRD Care (for large dialysis organizations)
Which track should providers choose?

Most providers should report under MIPS in 2017 unless they are new to Medicare or bill very low Medicare volume. CMS determines which providers qualify for APM status.

What are the potential payment adjustments under MIPS?

Eligible Clinicians who fail to report MIPS data will get penalized. 

What services and support can I expect from athenahealth around MACRA?
  • Data submission to CMS on your behalf
  • 90+ MIPS quality measures pre-built into our certified EHR
  • Dashboard that provides instant performance insight
  • Measures are surfaced at the point of care for seamless satisfaction
  • Performance monitoring & coaching to ensure you meet requirements
  • Audit support


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