MACRA – Who Are Are The Winners & Losers?

Signed on April 16, 2015 by President Obama, the Medicare Access and CHIP Reauthorization Act (MACRA) provides funding for the Children’s Health Insurance Program (CHIP) through 2017 and makes sweeping reforms to Medicare physician reimbursement (see Congress Reauthorizes CHIP Through September 2017). Additionally, MACRA:

  • Extends certain special payment add-ons for Medicare provider organizations, such as the ambulance add-ons and increased inpatient hospital payment adjustment for certain low-volume hospitals
  • Extends funding for abstinence education, the personal responsibility education program, the health care work force demonstration program, and other programs
  • Disallows Medigap plans, which cover 100% of out-of-pocket costs beginning with the first dollar
  • Increases Medicare premiums for beneficiaries with higher income beginning in 2018

The largest provision of MACRA, and the one that is getting all the attention, is the Quality Payment Program, which replaces the use of the sustainable growth rate to adjust physician payments. The Quality Payment Program applies to physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists participating in Medicare Part B. Within the program, there are two components eligible clinical professionals can participate in: the Merit-Based Payment System (MIPS) and the Alternate Payment Model (APM). Both components focus on moving from payment for services to payment for quality and value.

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