MACRA

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MACRA Resource Center

AAD's MACRA Resource Center offers a host of tools and resources so that your practice can be prepared, regardless of whether you’re on the Merit-based Incentive Program (MIPS) path, the Alternative Payment Model (APM) path, or choosing not to participate in either.


MACRA tools and resources

Access a wealth of resources to help you prepare your practice in the tabbed section below.

  • Overview

    The 2015 Medicare Access and Chip Reauthorization Act (MACRA) repealed the sustainable growth rate formula, or SGR, which had been the basis for determining annual updates to the Medicare fee schedule. MACRA guaranteed a positive annual update of .5% until 2019 and set goals to move Medicare payment from volume to value. The final rule issued by CMS in October outlines two pathways toward these goals:

    1. 4.MIPs.pngMerit-based Incentive Payment System (MIPS) combines existing Medicare reporting requirements into a single entity that ties fee-for-service payment to performance on an overall physician quality score. Initially MIPs will be the pathway for most physicians in the Medicare program. Beginning in 2019 it will replace payment cuts associated with PQRS, Meaningful Use, and the Value-based Modifier with the potential to earn a bonus or incur a penalty depending on your performance score. Learn more about how MIPS will impact your practice's revenue with the AAD's financial assessment tool.


    2. 5.APMs.pngAdvanced Alternative Payment Models (APMs) reward physicians who are participating in payment models that attempt to incentivize health care decision-making based on quality, outcomes, and cost savings. Beginning in 2019 until 2024 doctors participating in Advanced APMs will receive a lump sum bonus payment of 5% of their Medicare charges.

    The AADA recognizes that participation in either MACRA pathway poses significant challenges for dermatologists, especially those in private practice. We advocated aggressively with CMS for changes that were implemented in the final rule. Read more about AADA's advocacy efforts

    MACRA: An Introduction

    View the presentation below to get an overview of MACRA.

  • MIPS explained

    4.MIPs.pngMIPS will be the most likely pathway for dermatologists to participate in MACRA. MIPS combines CMS’s three existing reporting programs, PQRS, Value-based Modifier, and EHR Meaningful Use, under a single entity. Beginning in 2019 MIPS replaces penalties associated with these three programs with potential to earn a bonus or incur a penalty based on your overall MIPS performance score.


    Do you need to participate in MIPS? How might it affect your revenue? Find out with AAD's interactive assessment tool.


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    In the MACRA Final Rule, CMS announced physicians will be able to "pick their pace of participation" for the first performance period beginning Jan. 1, 2017. To avoid a payment penalty in 2019, physicians choosing the MIPS pathway must choose one of the options outlined below:

    1. Test the Quality Payment Program: Physicians may choose to submit one of the following options beginning Jan. 1, 2017:
      • One measure in the quality performance category at least one time*
      • One activity in the improvement activity category
      • Five required measures making up the base score of the advancing care information (ACI) category
      This option prevents physicians from incurring a negative payment adjustment.

      *The AAD strongly recommends practices report more than one measure or report at least one measure over a 90-day period as an insurance policy in the event of submission issues or inaccuracies. Failure to correctly report one measure or activity in 2017 will result in a 4% penalty in 2019.

    2. Participate for part of the calendar year: Physicians may choose to submit one of the following options for any 90-day period beginning Jan. 1, 2017 through Oct. 2, 2017:
      • More than one quality measure in the quality performance category
      • More than one improvement activity
      • More than the five required measures in the ACI category

      This option may allow for a "neutral or small positive payment adjustment".​

    3. Report all MIPS measures for 90 days: Physicians may choose to submit all of the following Quality Payment Program information for 90 days or the full calendar year:
    • Six quality measures in the quality performance category
    • One high-weighted improvement activity or two medium-weighted improvement activities
    • Five required measures making up the base score of the ACI category.

    This option may allow for a "modest positive payment adjustment". Please note that there are additional requirements for practices with more than 15 providers.

    MIPS metrics

    To calculate your MIPS score, CMS will evaluate your performance in four core areas. Scores in each area will be weighted. CMS has indicated the weights below for 2017 but will adjust these as the program evolves.


    • 7a.QualityReporting.pngQuality Reporting, 60%: This category evolves the PQRS requirements. You must report only 6 measures, rather than the 9 required under PQRS. Of the 6, one must be an outcome measure or high-priority measure. You must report measures for 50% of your population regardless of payer. Reporting may be completed via a registry such as DataDerm or via your EHR. You will receive 3 - 10 points for each measure based on how your performance compares to the benchmark. You can select any 6 measures or pick from the dermatology specialty measure set. Learn more about quality. 
    • 7b.AdvancingCare-Info.pngAdvancing Care Information, 25%:  This category assigns credit for your use of a certified EHR and replaces the requirements of the current Meaningful Use program. You will receive an overall score comprised of several elements:

      • Base score: 50 points for reporting 5 required measures.
      • Performance score: 90 points for reporting 9 optional measures which assess patient interaction and health information exchange.
      • 5 Bonus points: For participation in a registry such as DataDerm.
      • 10 Bonus points for completing improvement activities related to ACI.
      Required reporting may be completed via a registry like DataDerm, your EHR, or the CMS portal. Learn more about ACI.
    • 7c.ClinicalPractice-Improvement.pngImprovement Activities, 15%: A practice of 15 or fewer physicians will receive full credit for completing one high-weight activity or two medium-weight activities selected from a list of 90 activities qualified by CMS.
      You can report on these activities through a data registry such as DataDerm, your EHR, or the CMS portal. Learn more about improvement activities.
    • 7d.-Resource-userv.pngCost, 0%:  No reporting will be required for this category. CMS will assign your score based on claims data in 2017 and report it to you in your feedback report, but it will not account for your overall score.

    CMS will develop benchmarks for each of these measures and points will be assigned based on how your score compares to benchmark. Your overall score will be based on how you compare to others reporting the measure, which represents an evolution by CMS to pay for performance under MIPS from the pay for reporting approach of PQRS.

    MIPS timeline

    Your MIPS incentive in 2019 will be based on your 2017 performance. Incentives continue until 2022.
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    MIPS: Delving into the Details

    Watch the presentation below to learn more about how to participate in MIPS.

  • APMs explained

    5.APMs.pngAdvanced APMs will initially be the pathway less traveled by dermatologists and will be most accessible to those practicing in large academic centers or large multi-specialty group settings. To qualify you must meet benchmarks for the amount of payment you receive through an Advanced APM or the number of patients in an Advanced APM that you care for.

    Those who do successfully participate in this pathway will receive a 5% bonus payment from 2019-2024 and will be eligible for larger fee schedule updates beginning in 2026.

    Not all APMs will be deemed Advanced APMs, and not all who participate in Advanced APMs will qualify for the bonus payment. To receive the 5% bonus payment in 2019, qualified clinicians must have at least 25% of their Medicare Part B Payments or 20% of their Medicare patient population flow through the Advanced APM.

    Advanced APMs must meet the following requirements:

    • Be CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs
    • Require participants to use certified EHR technology
    • Base payments for services on quality measures comparable to those in MIPS
    • Be a Medical Home Model expanded under Innovation Center authority or require participants to bear more than nominal financial risk for losses.

    View a list of approved APMs.

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    Those who participate in an Advanced APM but do not qualify for the 5% bonus payment may still be able to forego MIPS participation; however, many clinicians will participate in both APMs and MIPS. In 2017, clinicians participating in APMs  and MIPS at the least will receive full credit in the improvement activities category.
  • Get ready
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    Starting preparing for MACRA implementation now:

    • Sign up for AAD’s DataDerm to submit quality measures.
    • Discuss your EHR’s MACRA readiness with your vendor.
    • Begin participating in PQRS and meaningful use if you aren’t already.
    • If you are in an Advanced APM, get on the list of qualified practitioners.

    download the MACRA readiness checklist

     


    How will MIPS affect your practice's bottom line?

    Take our interactive financial assessment by clicking on the image below.

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  • Help

    2.Question-mark.pngAsk an expert

    The Academy has launched an online discussion forum that allows members to ask expert staff questions about MACRA. AAD members also are encouraged to share their experiences and knowledge with their colleagues.

    Join the discussion

     

    Note: If you are already logged into aad.org, join the MACRA community now, or learn more about how to use the community.


    Latest discussion posts

    Q: As a solo provider, do we have to attest separately for each (MU, MACRA, and PQRS) or will it all be condensed into a single report we can submit through our EHR?. Keep reading.


    Q: Was the proposed Quality Measure for Non-melanoma Skin Cancer: Biopsy Reporting Time - Pathologist approved in the final MIPS rule?  It isn't listed on the CMS Explore Quality Measures - Select Measures website. Keep reading.


    Q: How do I assess MIPS impact if we can report on all required Quality Measures and Clinical Practice Improvement Activities but just 1 or 2 Advancing Care Information measures? Keep reading.