The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)


The Centers for Medicare & Medicaid Services' (CMS) Quality Payment Program (QPP) ended the Sustainable Growth Rate formula with the creation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA has two tracks that clinicians can choose from: the Advanced Alternative Payment Models (APMs), or the Merit-based Incentive Payment System (MIPS). If you provide care for more than 100 Medicare patients a year and bill more than $30,000 in Medicare Part B allowed charges a year or submit data for an APM, then you are in the MACRA program. The AJRR can help its participants meet the requirements for MIPS track. 

The Merit-based Incentive Payment System (MIPS)

The MIPS track can be very helpful to clinicians, as it will adjust Medicare payments based on the quality and completeness of data submitted to CMS.

Occupations eligible for MIPS include:

  • clinical nurse specialists
  • nurse practitioners
  • certified registered nurse anesthetists
  • physician assistants
  • physicians
For those who participated in MIPS in 2017, quality data and information on how your practice used technology needs to be submitted to CMS by March 31, 2018. Medicare will then provide feedback on your performance, and will give you either a negative, neutral, or positive payment adjustment in 2019. If you did not start collecting data by October 2, 2017, you will not be able to qualify for a positive payment adjustment in 2019.

MIPS allows participants four different options in the amount of data they want to submit for payment adjustment:

  • No Data
  • Minumum Amount
  • Partial
  • Full Year

When participants choose not to submit any data, they will receive a negative 4% payment adjustment. They can also choose to submit a minimum amount of data, which will give them a neutral payment adjustment. To qualify for this option, participants only need to submit one quality measure or improvement activity. The third option is for participants to submit 90 days of 2017 data to Medicare. These participants can earn anywhere from a neutral adjustment to the maximum payment adjustment. The final option is to submit all of 2017 data to Medicare. This will earn your practice a positive payment adjustment. The positive and negative adjustments increase each year of the program, as you can see in the diagram below.

MIPS Payment Adjustment Timeline








Now we’ll quickly go over the quality data and technology information categories that are required for MIPS. They are:

  • Quality
  • Advancing Care Information
  • Improvement Activities
  • Cost

You may recognize aspects of these MIPS categories, as most of them replace previous CMS initiatives. The Quality category replaces the Physician Quality Reporting System (PQRS). The Advancing Care Information category replaces the Medicare Electronic Health Record (EHR) Incentive Program, also known as Meaningful Use (MU). The Cost category replaces the Value-Based Modifier (VBM). The Improvement Activities category is new. Cost will be calculated by Medicare in 2017, but will not factor into your payment adjustment until the 2018 performance year.

How Can AJRR Help?

AAOS QCDR Splash Page

The American Academy of Orthopaedic Surgeons (AAOS) Orthopaedic Quality Resource Center is a collaboration between AJRR, the American Orthopaedic Association's (AOA) Own the Bone program, the American Association of Hip and Knee Surgeons (AAHKS), the Orthopaedic Trauma Association (OTA), and Premier Healthcare Solutions, Inc. It's approved by CMS as a Qualified Clinical Data Registry (QCDR). The QCDR provides a standard to complete Merit-based Incentive Payment System (MIPS) requirements based on satisfactory participation. A QCDR is a CMS-approved entity that collects medical and/or clinical data for the purpose of patient and disease tracking to foster improvement in the quality of care furnished to patients. 

The AAOS Orthopaedic Quality Resource Center is comprised of 38 measures, including three AAHKS-sponsored hip and knee measures and the Academy's own 2017 Orthopaedic Preferred Speciality (OPS) List. The AOA’s Own the Bone program has also provided measures that will remain as part of the platform. The AAOS Orthopaedic Quality Resource Center has been a QCDR since 2014.

The AAOS QCDR can assist Eligible Professionals (EPs) and organizations participating in the Group Practice Reporting Option (GPRO) across all orthopaedic specialties. The Resource Center’s MIPS reporting can satisfy the full MIPS program and prevent institutions from receiving up to a 4% negative payment adjustment. Besides for MIPS reporting, AAOS' QCDR can also automate EHR data, track performance against benchmarks, and help manage your patient population.

Register here to get started.

Download a brochure about the AAOS Orthopaedic Quality Resource Center here.

The Advanced Alternative Payment Models (APMs)

The AJRR can partially help meet one APM, the Comprehensive Care for Joint Replacement (CJR) model. Although AJRR cannot completely help meet the requirements for an APM, it is helpful for Registry participants to know that those who participate in APMs will receive a 5% incentive payment in 2019 if they care for 20% of their Medicare patients or receive 25% of their Medicare payments with an APM.

Additional Resources

Below are a few additional resources that you can use to become more familiar with MACRA:

The Register

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The Register

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