One of the latest additions to the ever-changing healthcare landscape is MACRA, the Medicare Access and CHIP Reauthorization Act. MACRA was signed into law in April 2016, to repeal the sustainable growth rate (SGR), a method used by CMS to control spending by Medicare on physician services. This continues to drive healthcare away from fee-for-service reimbursements to the goal of achieving the triple aim of high-quality, low-cost care with an exceptional patient experience. 

The final rule on MACRA was released October 2016 confirming 2017 will be the first performance year providers will be scored to determine payment adjustments in 2019. Clinicians can to be paid on a fee-for-service basis with pay-for-performance incentives and penalties through the Merit-based Incentive Payment System (MIPs) or receive a financial incentive through the Alternative Payment Model (APM).

Most clinicians are anticipated to choose MIPs as it aligns three current independent payment programs: Physician Quality Reporting System (PQRS), Value-based Modifier (VM), and Meaningful Use (MU), into one composite score.

Payments will vary among providers based on higher performance. In 2019, the maximum payment adjustment amount starts at 4% and incrementally climbs to 9% in 2022.