28 February 2017

MACRA is a federal program that redesigns several Medicare-related reporting and reimbursement structures. Most notably, it ends the current reimbursement schedules under the Sustainable Growth Rate (SGR) program and lays the framework for a new performance-based system to replace it.

The new payment structure will be based upon on quality, value, and accountability instead of volume, as seen in the pay-for-service model of SGR.

Under MACRA, several existing programs such as the following will be streamlined into a new Merit Based Program

  • PQRS
  • Meaningful Use
  • VBPM

MACRA will streamline these existing programs into one Merit-Based Incentive Payment System (MIPS). Medicare reimbursements will be adjusted based on performance in four key categories:

  1. Quality
  2. Meaningful use
  3. Clinical improvement
  4. Resources used

Many physicians are wondering if participating in this new program is worth the time and labor to collect the data required for reporting. For those physicians that opt-out of the program, significant cuts in Medicare and Medicaid reimbursement will be a concern. For those physicians that opt-out of the program, it may result in reducing the number of Medicare and Medicaid patients seen by the practice. Those patients would be replaced by patients with private pay 3rd party insurance.

If a physician opts-out of MACRA, they will no longer be required to provide online access to your health records. It is highly recommended that you ask your physician if they plan on participating with MACRA and continue to provide online access to your health records.