MACRA: Tracks and other impacts

MACRA: Tracks and other impacts

When the proposed rules around the Medicare Access and CHIP Reauthorization Act (MACRA) are more than 960 pages, it’s easy to understand how healthcare professionals at all levels are confused, trying to sort through the massive amounts of complexity.

One of the biggest discussion points regarding MACRA regards the two “tracks” of payment — the Merit-based Incentive Payment System (MIPS) and the advanced Alternative Payment program (APM). 

Which track makes the most sense for you? Well, according to Hospitals & Health Networks Magazine, it may not immediately matter as you won’t get to choose right away. In a recent article, Maggie Van Dyke explains the difference between the two tracks (

“MIPS is the default track that the Centers for Medicare & Medicaid Services culled from the current physician quality reporting and meaningful use programs,” she writes, outlining the four categories in which performance is measured: resource use, quality, clinical practice improvement, and health information.

“The advanced APM route is an elite track for physicians already invested in risk-based payment and meaningful use,” she continues.

Here’s the thing, though. According to Van Dyke, only five current federal programs currently qualify for advanced APMs. And the Centers for Medicare & Medicaid Services (CMS) has stressed one key point that many seem to be missing — most physicians will be assigned to MIPS for the first reporting period in 2019.

So, you don’t get to choose … at least for now. If you qualify for the advanced APM in future reporting periods, you could be moved or request to be moved later.

“It’s a strategic decision by the organization as to whether they want to move into, and experiment with, new payment models,” said Melissa Jackson, senior associate director of policy at the American Hospital Association, in the article. Your best plan of action at this point is to review both tracks and take a long-term approach for what makes the most sense for your practice … but realize that it’s extremely likely that you’ll be entered into MIPS for the first reporting period.

Here are other topics that you should become familiar with:

Be prepared for a lot of reporting rules.

Bing Pao, director of provider relations for CEP America, said in a recent article in Managed Healthcare Executive ( that he’s concerned about the complexity of the rules.

“Initially, it will be confusing, to say the least,” the article reads. “All this requires providers to: 1) fully understand the incredibly complex new rules; 2) successfully employ all measures outlined; and 3) perform, track and report based on MACRA measures.”

Think about outcomes and other wellness services.

MACRA allows physicians to be paid for quality care. That’s a good or a bad thing, depending on who you ask. Ann Kuenker, a Michigan-based wellness and prevention practitioner, says in Managed Healthcare Executive that MACRA shifts the accountability model and encourages increased counseling and follow-up.

“Accountability for their own health is ultimately the patient's responsibility,” the article reads. “However, since physician payment will be tied to the patient’s success, the comprehensive nature of a medically-sound weight-loss program makes it well suited for a successful outcome for both the practitioner and the patient.”

So, keep these things in mind as you continue your preparation for MACRA. Don’t stress about your track choice for now. Be prepared for a lot of potentially complex rules. And consider the impact on patient care, outcomes, and wellness services.

COVID-19 Resource Center    Visit our Resource Center to stay up to date.​