MACRA issues for providers to consider

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) presents several key issues for providers. In this article, Milliman’s Lynn Dong, Colleen Norris, and Christopher Kunkel examine the five considerations below related to MACRA and how they may affect providers. The authors also highlight details from the proposed regulation as well as potential implications for providers.

1. Under MACRA, the Medicare Part B fee schedule increases only slightly through 2019 and not at all from 2020 through 2025. After 2025, there will be minimal annual increases to the Part B fee schedule.

2. The Merit-Based Incentive Payment System (MIPS) consolidates and streamlines three existing programs, resulting in both negative and positive adjustments to providers’ current reimbursements.

3. MACRA encourages providers to participate in Alternative Payment Models.

4. Providers will need to make numerous decisions regarding the submission of quality metrics, participation in Clinical Practice Improvement Activities (CPIAs), and Advancing Care Information.

5. Participation in an Alternative Payment Model (APM) requires a careful review of potential financial risks and opportunities.

The article is part of a series examining the impacts of MACRA on providers, alternative payment models, and health plans. To read other articles in the series, click here.

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