MACRA may sound like a word jumble with terms like MIPS, APM, QPP, ACI, CPS, VBP, and so on. Unfortunately, a majority of physicians are unaware of how this new payment system will affect their practices, so making sense of these acronyms is just the beginning.
MACRA did more than replace the Sustainable Growth Rate formula. It will soon introduce a new framework for rewarding physicians who provide higher-value care. And, it will also introduce a number of new terms physicians and their staff should become more familiar with. Following is a short list of terms every physician should know before the new payment rules take effect Jan. 1.
QPP: The Quality Payment Program. This is that new payment framework. It offers two tracks for payment: MIPS and APMs, both discussed below.
MIPS: The Merit-based Incentive Payment System. MIPS aims to align three currently independent programs — quality reporting (what physicians know now as PQRS), Advancing Care Information (now known as EHR Meaningful Use), and cost (now known as the value-based modifier) — and adds a fourth component, Improvement Activities, designed to promote practice improvement and innovation. Some physicians will be exempt from MIPS through the low-volume threshold, defined below.
APMs: Alternative payment models. Few physicians will choose this track, as many APMs are not yet available in all states. APMs typically have shared savings, flexible payment bundles and other desirable features. There are two APM participation classifications—Advanced APMs, which have their own reporting requirements and are exempt from MIPS reporting, and MIPS APMs. Read more about APMs.
Pick Your Pace: This refers to the four participation options available in the transition year, which starts Jan. 1. Physicians may elect for MIPS testing, partial MIPS reporting, full MIPS reporting or Advanced APM participation. Read more about the four options.
Low-Volume Threshold: Physicians with less than $30,000 in annual Medicare revenue or fewer than 100 Part B-enrolled Medicare beneficiaries will be exempt from all MIPS reporting. Read more about accommodations for small practices.
ACI: Advancing Care Information. This replaces Meaningful Use. It features more reasonable reporting features, including base and performance scoring, fewer measures and 90-day reporting periods. Learn more about the two ACI options.
Improvement Activities: This new component, a feature of MIPS, is intended to provide credit for practice innovations that improve access and quality of care. It features more than 90 activities across eight categories. These too make accommodations for small practices. View a full list of activities.
Reporting Option: Physicians will need to decide whether to report as an individual or as part of a group. A group is defined as two or more eligible clinicians. A physician in a group may choose to participate as an individual under MIPS.