Frequently Asked Questions

What is MACRA / MIPS and why should I care?

MACRA was passed by Congress as the Medicare and CHIP Reauthorization Act of 2015 and signed into law by then-President Obama. It repealed the badly designed SGR (Sustained Growth Rate) formula, streamlined quality programs (like PQRS and Meaningful Use) and created a system of value based payments through Advanced Payment Models (APMs) and the Merit -based Incentive Payment System (MIPS). Together, they constitute the inaccurately named Quality Payment Program.

If you are a provider, how you are paid by Medicare has changed forever. The biggest change to the payment system is that the providers who can best game the system, will take money from the providers who can least game the system. This is groundbreaking in healthcare for two key reasons: 1) bonuses come from penalties, so it is now a competition for Medicare dollars, and 2) to be on the winning side you will need very effective data analytics.