The Medicare Access and CHIP Reauthorization Act (MACRA)

The Medicare Access and CHIP Reauthorization Act (MACRA) is a law that significantly changed how the federal government pays physicians, permanently repealing the flawed sustainable growth rate (SGR) and setting up the two-track Quality Payment Program (QPP) that emphasizes value-based payment.

• Track one is Merit-based Incentive Program System. MIPS adjusts payment based on performance in four performance categories—quality, cost, promoting interoperability, and improvement activities.
  
• Track two is Advanced Alternative Payment methods. AAPMs offer incentives to provide high-quality, cost-effective care. There are currently five AAPMs for primary care.

QPP for Employed Physicians

It is important for employed physicians to be informed about the QPP and how their organization participates (e.g., through MIPS or an AAPM). How an organization participates and performs in the QPP can have an impact on an employed physician’s Medicare payments.

• MIPS final scores are attached to individual national provider identifiers (NPIs), even for those reporting as a group. Should a physician change practices between the performance period and payment year, any payment adjustments would follow them to their new practice.
  
• Performance in MIPS could affect salary and compensation contracts. Since performance can result in either positive or negative payment adjustments, physicians should be prepared to see this reflected in employment contracts. A strong performance in MIPS should lead to higher salary/compensation for the physician. The AAFP has resources to help members navigate employment contracts.
  
• Physicians should also take into consideration the MIPS scores of practices they are considering joining.

Steps You Can Take Now to Realize Payment

Provide Medicare wellness and care coordination services to optimize fee-for-service revenue, improve quality, and decrease total cost of care. Services include:

• Annual Wellness Visits (AWV) -- Implement AWV to optimize revenue and improve Medicare quality and cost with minimal impact to your practice.
  
• Chronic Care Management (CCM) -- You and your team invest in caring for patients with chronic conditions. Get paid for it with CCM while also preparing for MACRA--without adding extra work.
  
• Transitional Care Management (TCM) -- Get paid for the time you invest in coordinating your patients' transition.
  
• Advance Care Planning (ACP) -- Guide your patients through end-of-life decisions and learn how to get paid for it.