The Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 makes sweeping changes to how Medicare will pay for physician services. The legislation repeals the flawed Medicare physician sustainable growth rate (SGR) formula and, instead, provides predictable payment increases. The law also calls for the Centers for Medicare & Medicaid Services (CMS) to implement a new two-track payment system for physicians and other eligible professionals. The intent of the two tracks is to tie an increased percentage of physician payments to outcomes through the Merit-based Incentive Payment System and to encourage the adoption of “alternative payment models” (APMs). APMs move payment away from fee-for-service reimbursement, and instead pay providers based on the quality and cost of care for particular episodes (e.g., bundled payment), or defined patient populations (e.g., accountable care organizations).
Implications for Hospitals and Health Systems. How CMS implements the changes contained MACRA will have a significant impact, not only on physicians, but also on the hospitals and health systems with whom they partner. Hospitals that employ physicians directly may bear some cost from implementation of and ongoing compliance with the new physician performance reporting requirements, as well as be at risk for any payment adjustments. Moreover, hospitals may be called upon to participate in APMs so that the physicians with whom they partner can qualify for the APM track.
Explore this webpage for resources and tools on key aspects of the new physician payment system. We welcome your questions and feedback, email us at MACRA@aha.org.
- Action Alert: Submit Comments to CMS on Proposed MACRA Physician Payment Program
- Model Comment Letter
- Webinar: The MACRA Proposed Rule: What You Need to Know
- Regulatory Advisory: MACRA Physician Quality Payment Program Proposed Rule
- Issue Brief: Physician Payment Reform — What is the MACRA?
- Webinar: Physician Payment After SGR Reform
- PPT Slides: Physician Payment After SGR Reform
- A Timeline of Physician Payment Transition
- AHA Physician Leadership Forum
Comment Letters and Other Policy-related Documents
- Special Bulletin: CMS Proposes Key Provisions of MACRA Physician Payment System for 2019
- AHA before House Ways & Means Subcommittee: Implementation of MACRA, May, 11, 2016
- Legislative Advisory: The 2015 Medicare Access and CHIP Reauthorization Act, April 22, 2015
- AHA before the House Subcommittee on Health: Implementation of MACRA, March 17, 2016
- AHA to CMS: Comments on Draft Measure Development Plan for the MIPS and APMs, March 1, 2016
- Trustee Magazine Executive Briefing: The Ins and Outs of Physician Payment after Medicare SGR Reform (Trustee subscriber resource)
- AHA to CMS: Comments to RFI on the implementation of the MIPS and APMs, Nov. 17, 2015
- Regulatory Advisory: Physician Fee Schedule Final Rule for CY 2016, Nov. 25, 2015
- Regulatory Advisory: Final EHR Incentive Program Rules, Nov. 3, 2015
- AHA to CMS: Comments on the physician fee schedule proposed rule for CY 2016, Sept. 8, 2015
Other Relevant Resources