MACRA

 
MACRA (Medicare Access and CHIP Reauthorization Act of 2015) replaces the flawed sustainable growth rate (SGR) and significantly changes the way Medicare pays physicians.

 

Many things about the Affordable Care Act (ACA; Obamacare) are likely to change under the new administration, but MACRA and the commitment to cost-effective, value-based care is here to stay. MACRA is separate from the ACA. Congress overwhelmingly passed MACRA legislation with bipartisan support in both chambers of Congress. MACRA will eventually transition physicians toward more value-based payments.

It is important to understand MACRA to ensure you are doing everything required under the current rules in 2017. Ignore MACRA in 2017 and you will face an automatic reduction of 4 percent to your payments under Medicare in 2019.

AGA offers educational webinars and videos to help you prepare:

Have questions? Visit the AGA Community to discuss MACRA and quality reporting with your colleagues.

Final Rule

The MACRA final rule, released in October 2016, confirmed that the first performance period begins Jan. 1, 2017, which CMS describes as a “transition year.”

The final rule provides additional details following the Sept. 8, 2016, announcement that CMS will allow physicians to pick their pace of participation for the first performance period.


Read the Rule

MACRA Timeline

 

Use AGA's Federal Quality Improvement Programs Timeline tool to find upcoming deadlines surrounding MACRA compliance.

 

What Do You Need To Do?

You need to prepare now for MACRA. Under the new legislation, what you do in 2017 may impact what you get paid in 2019. Choose the practice model below that best describes your practice to see what you need to be doing right now to avoid future penalties.

GI-Only Practices

MACRA will have a profound impact on GI-only practices, from solo practitioners to large groups. AGA has resources for your specific needs to help you prepare.

AMC & Multispecialty Groups

GIs employed by multi-specialty groups and academic medical centers shouldn't assume their institution will take care of their MACRA preparation. AGA identifies what you need to do to make sure you’re ready.

 

Which Payment Pathway Will Affect You?

The majority of eligible clinicians (defined to include physicians and others, such as nurse practitioners, physician’s assistants, certified nursing assistants and clinical nurse specialists) will initially participate in the MIPS track. CMS estimates 12,600 GIs will be subject to MIPS and 38.3 percent will get penalties. Plan now to avoid cuts.

Advanced APMS

Advanced Alternative Payment Model (APM)

  • Most appropriate for large systems.
  • Advanced APMs focus on care coordination, share financial risk.
  • Avoids MIPS penalties and qualifies for lump-sum incentive payments by adhering to stringent standards and risk-sharing requirements.
  • There are no GI-specific advanced APMs at this time.

MIPS

Merit-Based Incentive Payment System (MIPS)

  • Most GIs will participate in MIPS.
  • MIPS replaces current reporting systems.
  • Receive bonus or penalty based on four categories:
    • Quality.
    • Advancing care information (electronic health records).
    • Improvement activities.
    • Cost.
 

The GI’s Guide to MACRA

Walk through the basic information about key programs under MACRA.

Expand All

What is MACRA?

MACRA legislation was created to repeal the longstanding sustainable growth rate (SGR) formula, which threatened ongoing untenable cuts to physician payment. As part of the SGR repeal, Congress mandated that CMS undertake a major overhaul of existing payment and quality programs.

There is a five-year transition period to a more quality- and value-based Medicare program during which CMS provides stable payment updates to physicians. Once fully implemented, MACRA will absorb existing programs, such as EHR Incentive Program and meaningful use requirements, the Value-based Payment Modifier, and PQRS. Read More

What is the Quality Payment Program?

CMS recently released proposed rules implementing its new Quality Payment Program (QPP), which was created after Congress passed the MACRA legislation. The QPP provides physicians with the choice to participate in either the new Merit-based Incentive Payment Systems (MIPS) or, as an alternative to MIPS, advanced alternative payment models (APMs). Read More

What is Advancing Care Information?

Advancing Care Information (ACI) is one of four categories on which eligible clinicians will be scored. It was created to provide a measure of partial credit for clinicians who are making progress in implementing new technology. Read More

What are Improvement Activities?

Improvement Activities is one of four categories on which eligible clinicians will be scored. It  was created to lead to improvements in the patient care experience. Read More

Downloadable Guides to MACRA

MIPS At-a-Glance

Proposed Medicare and Quality reorms Report

The AGA Report on the Merit-based Incentive Payment System (MIPS) provides a comprehensive, but plain-language, analysis of the program, including specific requirements and how GI's can participate.

MACRA at a Glance

MACRA Infographic

Download a printable infographic with all the basics at a glance.

 

Additional MACRA Resources

 

Digestive Health Recognition Program

The AGA Digestive Health Recognition Program™ (DHRP) is a quality improvement program and clinical data registry that allows clinicians to demonstrate quality of care in colorectal cancer (CRC) screening and surveillance and in the treatment of hepatitis C virus (HCV) and IBD.

AGA DHRP

Performance Measures

AGA is a leader in performance measurement and has developed measures for several digestive health conditions and clinical topics including: colorectal cancer screening and surveillance, HCV and IBD.

Performance Measures

Regulatory Comments

AGA reviews proposed and final federal regulations to provide expertise and guidance on rules that will impact the field of gastroenterology, AGA members and their patient careWe provide substantive policy support and expertise to CMS and other regulatory departments since physicians are best suited to provide guidance to rules that will affect their patient care.

Regulatory Comments