MACRA and MIPS: What You Need to Know About Medicare Payment Reform

Dec 5, 2016
2 min read

Have you heard the terms MACRA and MIPS? Do you know Medicare payment reform is coming?

Are you aware of the changes coming to the healthcare system and how you will be subjected to them as a Medicare provider? In the last 5 years or so, the Medicare program has set forth a continuously evolving set of rules in order to cut costs and increase patient health returns. Doctors have been held responsible for outcomes regarding patient care and meeting certain objectives.

What is MACRA?

  • Stands for Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
  • Reward doctors for "value over volume"
  • Streamlines programs under MIPS
  • Provides bonus payments for participation in APMs (see below)

What does MACRA mean for doctors?

  • Combines PQRS, Value-Based Payment Modifier, and the Medicare EHR Incentive program into one- MIPS
  • Goal: Tie more physician payments into value
  • Begins January 2017

What is MIPS?

MIPS stands for Merit-Based Incentive Payment System.


What does MIPS mean for doctors?

  • Based on the composite score, optometrists will receive positive, negative or neutral adjustments up to certain percentages.
  • Exclusions: 1st-year medicare providers, below low volume threshold, and providers who participate in Alternative Payment Models who qualify for bonus


What is APMS?

APMS stand for Alternative Payment Models

What does APMS mean for doctors?

  • More risk, more reward then MIPS
  • Bonus payments for most advanced APMs


What action do doctors need to take?

  1. Quality holds the most weight. Of 200 sub-measures, doctors must pick 6 that most reflect their specialty. "General quality measures include activities such as effective clinical care, patient safety, community/population health and communication and care coordination."1
  2. Advancing care standards are replacing Meaningful Use. This includes tasks such as the  prescribing electronically, send messages securely and showing that a practice has analyzed security risks1.
  3. Doctors must choose between 90 clinical improvement activities to improve patient safety and coordination of care.
  4. Doctors don't specifically report on resource use, but information will be obtained by claims sent by providers.

4 Keys To Success

  1. Test your Meaningful Use procedures in 2016
  2. Continue to participate in PQRS
  3. Survey the 90 options to date for clinical practice improvement activities to see which ones would best fit your practice
  4. Use the existing feedback reports to measure performance
1. Finkel, By Ed. "MIPS Explained: 4 Categories Physicians Must Master." Medical Economics. Medical Economics, 10 Aug. 2016. Web. 23 Sept. 2016. <>.
About Courtney Dryer, OD

Courtney Dryer is a 2011 graduate of SCO. She opened 4 Eyes Optometry in her hometown of Charlotte, NC in February of 2013. After 5 years, the practice name was changed to Autarchic Spec Shop to renew the practice's commitment …