Piecing Together the MACRA Puzzle
Heart of Health Policy | It’s been almost one year since the health care community celebrated the permanent repeal of the Sustainable Growth Rate (SGR) and shifted its focus to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation that establishes a framework for rewarding clinicians for value over volume, streamlines quality reporting programs into one system and reauthorizes two years of funding for the Children’s Health Insurance Program (CHIP). While MACRA holds significant promise for the future of health care delivery, there is still an abundance of unknowns that have caused anxiety for health care professionals. As the journey continues, the ACC is dedicated to helping its members piece together the MACRA puzzle.
Get the Facts: What Does MACRA Do?
- Repeals the SGR formula used for determining Medicare payments to clinicians. The SGR does not exist.
- Reauthorizes funding for CHIP for two years through Fiscal Year (FY) 2017.
- Extends funding for direct and indirect graduate medical education payments to teaching health centers through FY 2017.
- Establishes a period of positive payment increases by providing an annual 0.5 percent payment increase for clinicians through Dec. 31, 2018, to support a predictable transition from fee-for-service to quality-based payment.
- Promotes the transition to quality-based payment by implementing two payment pathways for clinicians beginning in 2019: the new Merit-Based Incentive Payment System (MIPS) or participation in eligible Alternative Payment Models (APM).
- Supports participation in APMs by providing annual payment increases of 0.75 percent to those participating in an eligible APM in 2026 and beyond, and 0.25 annual payment increases to all other clinicians.
- Declares a national objective to achieve widespread exchange of health information through interoperable certified electronic health record technology nationwide by Dec. 31, 2018.
- Includes a provision that will protect clinicians by preventing quality program standards and measures (such as Physician Quality Reporting System/MIPS) from being used as a standard or duty of care in medical liability cases.
Resources to Navigate MACRA
The ACC has numerous resources to help navigate MACRA. Visit ACC.org/MACRA to access:
- Issue briefs on MACRA, MIPS and APMs
- Articles from ACC publications including the Journal of the American College of Cardiology and Cardiology magazine
- ACC Advocacy action including comment letters
- Webinars on MACRA developments and payment models
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