MACRA-economics 101: Prepare today for tomorrow's outcomes

Together, MIPS and APMs establish a new framework that streamlines existing quality reporting programs into one system and, in doing so, fundamentally changes how clinicians get paid.

Starting in 2019, Centers for Medicare & Medicaid Services, will change how they pay physicians in a profound way. Unfortunately, the details are complicated and confusing, and many of the particulars have yet to be worked out, which has led many healthcare leaders to glaze over the details and focus on more immediate concerns.

However, disengagement is a strategic mistake because while the Medicare Access & CHIP Reauthorization Act of 2015, or MACRA, details are intricate, the outline is clear. Providers and healthcare organizations must begin now to prepare for advanced value-based care models to maximize the benefits from MACRA.

MACRA's repeal of the Medicare Sustainable Growth Rate, the prior standard set of changes used to implement the physician fee schedule, was an attempt by Congress to control ever-rising medical costs. In SGR's stead, Congress has implemented the MACRA, which consists of the Merit-based Incentive Payment System, or MIPS, and Alternative Payment Models, APMs.

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