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Medicare Eases MACRA Rules

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September 9, 2016


The Centers for Medicare & Medicaid Services is giving physicians more options in deciding when to begin reporting quality performance data under the 2015 Medicare Access and CHIP Re-Authorization Act (MACRA), the new physician payment program which links payment to the quality of care physicians provide.  MACRA replaced the Sustainable Growth Rate, or SGR, formula for physician payment updates.


CMS originally said it would require physicians to start reporting quality performance under the new program in January 2017.  Acting CMS Administrator Andy Slavitt however, said the agency will allow physicians to pick the pace of their participation in 2017.  Among the options:


  • Report some data: As long as physicians submit some quality performance data to CMS, including data after January 1, 2017, they will avoid a negative payment adjustment.  This option is designed to let physicians determine that their practice’s quality reporting system is working and is prepared for broader participation in 2018 and 2019.
  • Participate for part of year:  Physicians can choose to submit quality payment program information for a reduced number of days in 2017.  In so doing, the practice could still qualify for a small positive payment adjustment.
  • Participate for full year:  Practices that are ready can choose to submit quality information for the full calendar year and potentially qualify for a modest positive payment adjustment.
  • Participate in Advanced Alternative Payment Models:  Instead of reporting quality data, physicians can join Advanced Alternative Payment Models, in which the physician shares in financial risk.  This includes Medicare Shared Savings Accountable Care Organizations that participate in Tracks 2 or 3; Next Generation ACOs; and medical homes under Medicare’s Comprehensive Primary Care Plus (CPC+).


View statement by CMS Acting Administrator Andy Slavitt


May 3, 2016 Reimbursement Simplified story on MACRA

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