Posted October 17, 2017 by admin in articles

MACRA is Coming – Is Your Practice Ready?


The American healthcare system is preparing for one of the most significant changes since Medicare was introduced in 1965. If your practice isn’t prepared for MACRA, learn why you should take action now.

What Exactly Is MACRA?

Introduced back in 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) changes the way Medicare reimburses physicians. The landmark legislation effectively replaces the existing Medicare reimbursement schedule with a new pay-for-performance model, focused on value, quality and accountability.

To effectively prepare for MACRA, your organization will need a solid readiness plan that includes medical practice software which can help you organize electronic health records, monitor physician performance, and report the required quality measures to the Centers for Medicare and Medicaid Services (CMS).

What Payment Tracks Are Available?

MACRA will offer a pair of primary payment tracks: Advanced Alternate Payment Model (AAPM) and Merit-based Incentive Payment System (MIPS). About 80 to 90 percent of practices will fall into the MIPS track, which will calculate their payment adjustments by scoring providers on clinical practice improvement, resource use, overall quality, and the use of EHR technology. These adjustments are expected to be significant, ranging from minus-4 percent to plus-9 percent, depending on provider’s score.

Physicians who enroll in AAPMs will receive lump-sum Medicare Part B incentive payments instead of payment adjustments under MIPS.

How is MIPS Performance Scored?

The Merit-based Incentive Payment System produces a composite score based on meaningful use of certified EHR technology (25%), Clinical Practice Improvement (15%), Cost or Resource Use (10%), and Quality (50%).

How Will Performance Data Factor into Payment Adjustments?

CMS will assign groups or clinicians composite scores, ranging from 0 to 100. After calculating a mean score for all MIPS participants, CMS will measure each score against this performance threshold. An organization’s adjustment will then be determined based on where its score sits on the sliding scale. CMS is maintaining a $500 million pool to reward high performers, which can get 0.5 percent to 10 percent positive adjustments if they fall in the top quartile.

What Are the Immediate Reporting Requirements?

After widespread backlash against initial requirements, CMS modified its demands for 2017 to include:

  • To avoid penalties, organizations must report every single measurement under Clinical Improvement, Quality or ACI measures.
  • To qualify for small bonuses, organizations have to report a full three-month period for a minimum of two of these measurements.
  • To secure a full bonus and any extra payments, an organization must report a full three-month period for every required category.

When Should We Start Preparing?

Healthcare providers should have started preparing a MACRA strategy starting January 1st, 2017. This is because any data collected during the 2017 calendar year will be incorporated into 2019 payment adjustments. If your organization hasn’t already, it should begin preparing as soon as possible, since performance data must be submitted to the Centers for Medicare and Medicaid Services by March 31, 2018.

If you are unsure how to prepare for MACRA, consider working with an outside consultant that can help you embrace value-based care with confidence.


Christopher Emper, JD, MBA

Government Affairs Advisor/NextGen Healthcare

President/Emper Healthcare Advisors, Washington, D.C.


Chris Emper is president of Emper Healthcare Advisors, a government affairs and healthcare consulting firm in Washington, D.C. The firm specializes in helping physicians and technology companies successfully navigate complex regulations and new value-based reimbursement models. Prior to forming Emper Healthcare Advisors in 2016, Chris was vice president of Government Affairs at NextGen Healthcare and Chair of the Electronic Health Record Association (EHRA) Public Policy committee. An expert in The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Chris is a frequent speaker at industry conferences and has written or appeared in articles in publications such as Politico, Health Data Management, Accountable Care News, and Medical Economics. Chris also currently serves as Chair of the HIMSS Government Relations Roundtable, a leading coalition of health IT government affairs professionals. Prior to joining NextGen Healthcare in 2013, Chris served as a Domestic Policy Advisor for former Massachusetts Governor Mitt Romney’s 2012 Presidential Campaign. There he advised the campaign on policy issues including healthcare, technology, and innovation. He holds a law degree and an MBA from Villanova University and a BA from Boston College.

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