Final MACRA Regulations Bump More Than Half of Clinicians Out of MIPS

October 14, 2016 – Robert Lowes

The federal government today issued final regulations for the Medicare Accountability and CHIP Reauthorization Act (MACRA), which now exclude or exempt between 53% and 57% of physicians and other clinicians from a possible 2019 penalty in the new reimbursement system.

The Centers for Medicare & Medicaid Services (CMS) gave roughly 200,000 more clinicians this break mostly by redefining practices that would not have to participate in the new system because their involvement with Medicare is minimal. In its proposed MACRA regulations, CMS defined such low-volume providers as having less than $10,000 in Medicare-allowable charges and fewer than 100 Medicare patients. By raising the dollar threshold to $30,000 in the final regulations, the agency bumped up the number of low-volume providers from 226,000 to 384,000.

Of these 384,000 low-volume providers, 46% work in practices with fewer than 10 physicians, according to CMS. Organized medicine had complained that many small practices lacked the time, money, and expertise to master the new payment program by the time it goes into effect in 2017. The agency has repeatedly said that it’s heard those complaints and is trying to make the new system more physician-friendly.

MACRA shifts Medicare reimbursement from fee-for-service (FFS) to pay-for-value through a new framework called the Quality Payment Program (QPP). There are two tracks in QPP. The default track, which initially will encompass the most physicians, is the Merit-Based Incentive Payment System (MIPS). It combines three existing incentive programs: meaningful use of electronic health records (EHRs), the Value-Based Payment Modifier, and the Physician Quality Reporting System (PQRS). Physicians will receive a bonus or penalty based on their composite score across the performance categories of quality of care, cost of care, clinical practice improvement, and meaningful use of EHRs, now called advancing care information.


Josh Sandberg

Josh Sandberg is the President and CEO of Ortho Spine Partners and sits on several company and industry related Boards. He also is the Creator and Editor of OrthoSpineNews.

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