GE Healthcare Camden Group Insights Blog

MACRA Final Rule Released Revealing Changes

Posted by Matthew Smith on Oct 17, 2016 10:09:29 AM

This past Friday morning, October 15, 2016, the Department of Health and Human Services released its final rule (with a comment period) on the Quality Payment Program ("QPP"), a part of the Medicare Access and CHIP Reauthorization Act of 2015 ("MACRA").

The QPP has two tracks: the Merit-Based Incentive Payment System ("MIPS") and the Advanced Alternative Payment Model ("APM").

Compared with the proposed rule, the main changes in the final rule include:

  • support for small and independent practices
  • expansion of APM opportunities
  • flexible 2017 reporting options
  • a focus on a unified program that supports clinician-driven quality. 

CMS launched a new Quality Payment Program website where the final rule, along with educational material, can be found. This website will be a great resource for eligible clinicians as they rollout QPP activities in 2017. 

For More Information:

Learn more about the details of the final rule in GE Healthcare Camden Group's webinar: "Chart Your Course for MACRA Success" this Thursday, October 20th. To register for this complimentary webinar, please click the button below.

Webinar, MACRA

Topics: CMS, Final Rule, MACRA, MIPS, QPP, APM

This is the MACRA Webinar You've Been Waiting For

Posted by Matthew Smith on Oct 6, 2016 12:06:37 PM

Please join GE Healthcare Camden Group for a complimentary, 60-minute webinar, Chart Your Course for MACRA Success, on Thursday, October 20, 2016, at 12:00 P.M., ET.


In April 2015, the Medicare Access & CHIP Reauthorization Act of 2015 ("MACRA") was passed, ending the Sustainable Growth Rate ("SGR") formula for determining Medicare payments for healthcare providers’ services. MACRA is intended to accelerate moving care delivery toward quality and value-based reimbursement models through the new Merit-Based Incentive Payment System ("MIPS") and incentive payments for participation in certain Alternative Payment Models ("APMs").

This law has a strict timeline to implement strategy to maximize possible incentive payments, improve care delivery and design, and successfully achieve efficiencies improving cost and quality that will go into effect 2019 based on the 2017 performance reporting period. While the final details of the incentives for the new payment models will not be defined until CMS publishes the final rule in November 2016, there are several things you can begin doing to determine optimum strategy and prepare for 2017.


In this complimentary webinar, members of the GE Healthcare Camden Group consulting team will deliver an overview of the legislative details of the new payment reform law and the implications of MACRA. They will also provide the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs.


Thursday, October 20, 12:00 P.M., Eastern

Learning Objectives:

  • Learn the timing and timeline for MACRA implementation
  • Review the two tracks for participation, APMs and MIPs
  • Examine the incentives and penalties associated with MACRA
  • Gain insight on MIPs Composite Score:
  • Understand what it will take to be successful under MACRA
  • Master the steps to take to begin the path to APMs

GE Healthcare Camden Group Presenter:

Hawkins_New.jpgCami Hawkins, Manager

Ms. Hawkins is a manager with GE Healthcare Camden Group and has more than 20 years of experience in the healthcare provider sector as a management consultant. She specializes in the areas of practice operations, contract negotiations, benefits administration, reimbursement management, and market development. Ms. Hawkins assists a wide range of provider organizations, healthcare systems, and independent and employed physician groups with addressing issues impacting their overall performance and competitive positioning. Her key areas of expertise include strategic planning, population health strategy.

To Register:

To register, simply click the button below, complete a short registration form, and press the "Cick to Register!" button. We will provide dial-in information and a WebEx link via email the week of the webinar.

Webinar, MACRAQuestions?

Please contact Matthew Smith at

Topics: Webinar, MACRA, Cami Hawkins, MIPS, APM

Two New Infographics to Help You Understand (and Explain) MACRA

Posted by Matthew Smith on Aug 11, 2016 2:53:14 PM

As you've likely learned, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years via two pathways:

  1. The Merit-Based Incentive Payment System (“MIPS”)
  2. Alternate Payment Models (“APMs”), which will take effect starting in 2017

These two new infographics, created by the American College of Rheumatology and the American Academy of Neurology, respectively, illustrate the two pathways and provide a visual reimbursement timeline. Links to full-size renderings of each infographic are available beneath each graphic.

To read more of GE Healthcare Camden Group's thought leadership surrounding MACRA, please link to the Insights Blog articles below:

Making Sense Out of MACRA and Alternative Payment Models

Top 10 Actions to Take Now to Prepare for MACRA

MACRA: How the New Merit-Based Incentive Payment System Will Impact Physician Practices

National Association of ACOs: MSSP Commitment Hinges on MACRA Advancecd APM Bonus Eligibility

MACRA-the-Big-Idea.pngFor full-size rendering click here


For full-size rendering click here


Topics: Infographic, MACRA, Alternative Payment Models, MIPS, Merit-Based Incentive Payment System, APM

Making Sense Out of MACRA and Alternative Payment Models

Posted by Matthew Smith on Aug 4, 2016 3:57:47 PM

By Marc Mertz, MHA, FACMPE, Vice President, GE Healthcare Camden Group

Providers may have developed a false sense of security that time is on their side—MACRA does not start until 2019, right?  While 2019 is the official date for the new payment models, performance beginning January 1, 2017, will determine 2019 payment adjustments.

CMS published the proposed rule defining their intentions under the new Quality Performance Program on May 9, 2016, and accepted comments on the proposed rule until June 27, 2016. CMS is expected to release the final rule by November, but their goal has remained firm: move 80 percent of Medicare payment to alternative payment models (“APM’s”) by the year 2020.

Path of Advanced APMs

While it may make sense for the majority of providers to initially go down the path with Merit-Based Incentive Payment System (“MIPS”), here is the critical information providers should know if they plan to participate in an Advanced APM.

MACRA outlines significant incentives to encourage providers to participate in Advanced APMs, including a 5 percent bonus starting in 2019 and an exemption from MIPS. The Advanced APM program, unlike MIPS, has no potential penalties. However, participation will not come easy. CMS set the standard high and challenges providers to satisfy the Advanced APM criteria.

  • Advanced APMs require providers to accept risk for delivering coordinated, high-quality care. As proposed, Advanced APM models must be a CMS Innovation Center model, a Medicare MSSP ACO, a demonstration under the Health Care Quality Demonstration Program, or a statutorily required demonstration and must meet the following additional requirements:
    • Utilize certified EHR technology
    • Report quality measures comparable to MIPS measures
    • Assume more than nominal financial risk

Initially only the following five Advanced APMs will be recognized under the new rule:

  • Medicare Shared Savings Program (“MSSP”) (Track 2 and Track 3)
  • Next Generation ACO Model
  • Comprehensive Primary Care Plus
  • Comprehensive ESRD Care Model
  • Oncology Care Model

Exclusions Apply

To the dismay of some, three programs have been excluded:  MSSP Track 1, Comprehensive Care for Joint Replacement (“CJR”), and Bundled Payments for Care Improvement (“BPCI”).

CMS will add new payment models and continue to modify models in coming years that satisfy the criteria to qualify as an Advanced AMP. Until 2021, participation requirements for Advanced APMs are only for Medicare payments or patients.

If your organization is trying to determine if moving to an Advanced APM makes sense, you should conduct an organizational self-assessment to identify current capabilities and those still needed to achieve status as an Advanced APM. It is imperative to understand the clinical and technical capabilities, resources, and skills necessary to be successful.

Key Considerations

  • Do you have progressive financial and clinical data analytics and reporting capabilities?
  • Are you prepared to invest in technology and care model redesign to improve clinical quality, reduce inefficiencies, improve provider/patient engagement, and optimize financial performance?
  • Do you understand the financial implications of the new reimbursement methods and the extent to which costs must be reduced and where and how providers will be incentivized to achieve these objectives to produce improvements in care coordination and quality?

There is not a one-size fits all strategy, so it is important to know your readiness to participate in an Advanced APM, the different care delivery needs of the community, the scope of risk to be taken, and have the infrastructure in place that will be necessary to achieve success.


MertzM.jpgMr. Mertz is a vice president with GE Healthcare Camden Group and has 18 years of healthcare management experience. He has 15 years of experience in medical group development and management, physician-hospital alignment strategies, physician practice operational improvement, practice mergers and acquisitions, medical group governance and organizational design, clinical integration, and physician compensation plan design. He may be reached at  



Topics: Marc Mertz, MACRA, Alternative Payment Models, APM

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