The Healthcare Guys: MACRA & MIPS

MACRA (Medicare Access and CHIP Reauthorization Act) and MIPS (Merit-based Incentive Payment System) are programs established by the Centers for Medicare and Medicaid Services (CMS) to help improve the quality and value of care provided to Medicare beneficiaries.

MACRA, which was passed in 2015, created a new framework for how physicians and other healthcare professionals are reimbursed by Medicare. It replaced the previous reimbursement system, known as the Sustainable Growth Rate (SGR), with a new system that focuses on paying for value and quality of care rather than the number of services provided.

MIPS is one of the two payment tracks under the new framework of MACRA, the other being Alternative Payment Models (APM) which focuses on paying for value and quality of care. MIPS is designed to incentivize healthcare providers to improve their performance in four key areas: quality, cost, advancing care information and clinical practice improvement activities.

The performance of healthcare providers is measured using a composite score and based on the score, the provider is either rewarded, penalized, or neutral. The goal of MIPS is to improve the quality of care provided to Medicare beneficiaries while reducing costs.