8 Key Facts About MACRA

Leigh Page


October 25, 2016

In This Article

Getting to Know MACRA

The Medicare Access and CHIP Reauthorization Act (MACRA) is a multifaceted law that's going to change the way you practice for years to come.

As Medscape reported earlier, MACRA covers such issues as data reporting, new practice models, evolving clinical standards, and physician evaluations. It also involves hundreds of millions of dollars in potential penalties and bonuses.

Although physicians are beginning to learn about MACRA and get more familiar with it, there is still more to know. So here are some facts that are worth your attention.

1. Almost Qualifying as an Advanced APM Counts for Something

The next level below "qualified providers" (QPs) in the MACRA hierarchy will be occupied by "partial QPs"—clinicians who don't quite make it to QP status, but still get some reward for their efforts. Partial QPs won't get the 5% bonus, but they can opt out of Merit-Based Incentive Payment System (MIPS) reporting.

Partial QPs would have to be in an advanced alternative payment model (APM). In the first year of the program, they would have to receive 20%-25% of their Medicare payments and 10%-20% of their patients from advanced APMs, and those percentages would rise after that.

If partial QPs decide to stay in MIPS, they would enjoy many benefits, such as not having to report MIPS quality measures, because APMs report 33 measures already. Presumably, QPs' greater familiarity with metrics means they might become high performers in MIPS and thus could win hefty bonus payments.


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