The Medicare Access and CHIP Reauthorization Act replaced the flawed sustainable growth rate formula with predictable payment increases. Implementation will have a significant impact on physicians and other clinicians, as well as the hospitals and health systems with whom they partner. For more information and educational resources, visit www.aha.org/MACRA.
Performance measurement begins in 2017
Different Payment Pathways:
Merit-based Incentive Payment System, or MIPS
or Alternative Payment Models, or APMS
Eligible Clinicians
Default payment pathway for clinicians, other than those with low Medicare volume or participants in advanced APMs.
Alternative to MIPS for clinicians with significant participation in risk-bearing APMS.
Payment Impact
Sliding scale bonuses and penalities ranging from 4 percent to 9 percent, starting in 2022
Bonus of 5 percent of Part B professional services payments in 2019-2024.
Evaluation Criteria
Performance evaluated based on:
- Quality
- Resource use
- Improvement activities
- Advancing care information (electronic health records)
Percentage of care delivered through an advanced APM; individual APMs incorporate cost and quality metrics but with no impact to bonuses.
