MACRA and the move to value-based healthcare

Kelly Whittle MIPS MACRA webianrRecently, Kelly Whittle, founder and CEO of Whittle Advisors, led a webinar for Quest Diagnostics discussing MACRA regulations, objectives, and key components to help practices develop a strategy for becoming compliant. This blog highlights some of the information she shared. You can view the full webinar here.

Today’s shift to value-based healthcare is designed to provide better patient outcomes, lower cost, and improved population health. Achieving these results requires a strong relationship between patient, payer, and provider, and requires quality reporting to reflect these efforts.

As you’ve already heard, the Medicare Access and CHIP Authorization Act (MACRA), also referred to as the Quality Payment Program (QPP), replaces the Sustainable Growth Rate formula. To reduce the administrative burden for providers in the move from fee-for-service to value-based healthcare, MACRA requires physicians to adopt one of two models, the Merit Based Incentive Program (MIPS) or Alternative Payment Models (APMs).

2017 is the transition year to MACRA. Practices have until March 31, 2018 to submit data for the first year, and payment adjustments begin in 2019, when you may earn a 5% payment incentive. Not participating in 2017 can result in a penalty in 2019. That means it’s time to pick your pace for 2017 and  develop a strategy to monitor the data now.


Those who are eligible for MIPS include clinicians billing over $30,000 per year to Medicare Part B and serving 100+ Medicare patients per year. Providers are evaluated in 4 categories that make up a 100-point MIPS score, and individual providers will be ranked nationally against their peers. For all physicians participating in MIPS an official MIPS composite score will be listed online on the Centers for Medicare and Medicaid Services (CMS) Physician Compare Portal.

During 2017 the following weights apply to each category–quality: 60%; cost: 0%; improvement activities: 15%; advancing care information: 25%.

MIPS performance categories


It’s recommended that, long term, 2 categories are prioritized over others: quality and cost. Quality will be heavily weighted in the first years and will differentiate the middle- and bottom-tier performers. Cost will be calculated in 2017, but will not be used to determine your payment adjustment in the first year. In 2018 cost will start determining your payment adjustment and will increase in weight, differentiating the top and middle performers. The categories for bonuses will shift as your peers perform at higher rates, which is one reason it’s important to get started now.


Participating in an APM requires that providers take on some risk related to patient outcomes. Some of the models which qualify for APMs include:

  • Comprehensive End Stage Renal Disease (ESRD) Care Model
  • Comprehensive Primary Care Plus (CPC+)
  • Medicare Shared Savings, Program Track 2
  • Medicare Shared Savings, Program Track 3
  • Next-Generation ACO Model
  • Oncology Care Model Two-Sided Risk Arrangement

Those participating in an APM are excluded from MIPS and can receive a 5% payment incentive.  To participate, your model must run on certified EHR technology, track and report data for quality measures, and be an expanded medical home or bear more financial risk.

Eligible clinicians must be on an APM-participation list on at least 1 of the 3 snapshot dates (March 31, June 30 or August 31, 2017), or must report to MIPS to avoid penalty.

Pulling it all together

Whether you decide to participate in MIPS or an APM, here are 3 things to know about the QPP:

  1. It is not an isolated program. MACRA fits into a broader CMS strategy to align medical practices with the transitions already underway in hospitals and ancillary care.
  2. It is not business as usual. You have to prepare to transition from fee-for-service to a value-based healthcare framework.
  3. It is not a technology task. Success is not found by ticking the boxes associated with technology requirements. Yes, you need certified EHR technology as a foundation, but you also must improve capabilities over time.

A key to succeeding with value-based healthcare is being able to leverage data and analytics, having transition care collaboration, and having continual improvement in clinical care, documentation, and cost reduction. For more information on the MACRA, visit

We’re ready

Quanum EHR is fully certified based on our 2014 Edition Certification and the regulatory requirements. MACRA requires certified EHRs to advance to the 2015 Edition Certification by 2019. Quanum EHR is actively advancing to the 2015 Edition Certification  to support you. To learn more about our certified EHR technology, contact us at 1.888.835.3409.

To learn more about MACRA,  watch our webinar.

Leave a Reply

Your email address will not be published. Required fields are marked *

Time limit is exhausted. Please reload CAPTCHA.