The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation which permanently repeals the Sustainable Growth Rate (SGR), 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), was signed into law in April 2015.
MACRA’s passage into law is a culmination of over two years of close collaboration with members of Congress on both sides of the aisle and a broad array of stakeholders, including the ACC. The law touches upon many areas across the health care spectrum.
As with many laws, MACRA is written with broad directions that will be implemented through more specific regulation by the federal agencies. The ACC is already engaging the Department of Health & Human Services (HHS) through the regulatory process to establish details of how the law will function.
Beginning July 1, 2015, clinicians began receiving a 0.5 percent payment increase to Medicare payments. This payment increase will continue annually until Dec. 31, 2018. Starting in 2019, there will be two pathways for clinician payment: the Merit-based Incentive Payment System (MIPS) or participation in eligible Alternative Payment Models (APMs).
As the MIPS is implemented, performance-based bonuses and penalties will be phased in. Starting in 2026, annual payment updates will be determined by the eligible professional’s participation in eligible alternative payment models or traditional Medicare reimbursement linked to quality.
What MACRA Does
- Repeals the SGR formula used for determining Medicare payments to clinicians. The SGR no longer exists.
- Establishes a period of positive payment increases by providing an annual 0.5 percent payment increases for clinicians beginning July 1, 2015, and ending Dec. 31, 2019, 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 MIPS or an eligible APM.
- Supports participation in eligible APMs by providing annual payment increases of 0.75 percent to those participating in a qualifying APM in 2026 and beyond, and 0.25 annual payment increases to all other clinicians.
- Reauthorizes funding for CHIP for two years through FY 2017.
- Prohibits implementation of 2015 Medicare Physician Fee Schedule provisions requiring the transition of all 10-day and 90-day global surgical packages to 0-day global periods.
- Expands the use of Medicare data for transparency and quality improvement by removing barriers and allowing for Medicare data to be provided to qualified clinical data registries to facilitate quality improvement.
- Requires that the HHS Secretary draft a plan for development of quality measures to assess professionals, including non-patient-facing professionals.
- 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.