GE Healthcare Camden Group Insights Blog

Infographic: 10 Things to Know About MACRA

Posted by Matthew Smith on Dec 2, 2016 1:57:48 PM

Our colleagues at Athena Health created the infographic, below, to help providers and medical practice professionals understand the complex MACRA mandate and resulting payment adjustments. 

Why settle for a neutral or small positive adjustment in 2019? Why not GO BIG with MIPS in 2017? Earn an exceptional performance-positive adjustment on top of the possible payment adjustment of up to 4%.

CMS is funding a pool of $500 million for exceptional performers who achieve a final score of 70 points or higher. With a final score between 70 and 100, (subject to the application of a scaling factor by CMS), eligible clinicians would receive a payment increase above 4% in 2019.

In addition to the positive adjustment, Going BIG would promote your clinicians’ social reputation (Physician Compare) and accelerate the shift towards value--including future participation in Advanced Alternative Payment Models.

Are you ready to Go Big and be an exceptional performer in 2017?

  • Have you successfully reported PQRS in previous years and on track in 2016?
  • Have you successfully attested to the EHR Incentive Program (Meaningful Use)?
  • On your Quality and Resource Use Report (QRUR), do you compare favorably?
  • Are you ready to move toward value-based care?

If you answered yes to these questions, you're already on your way. 

Let GE Healthcare Camden Group help you reach your MACRA potential and maximize your MIPS payments. To get started, simply click on the button below and one of our MACRA experts will contact you.


MACRA Infographic.jpg

Topics: Infographic, Healthcare Infographics, MACRA, MIPS

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

MACRA, MIPS, and CPIA GO!: Tips for Success

Posted by Matthew Smith on Oct 5, 2016 12:56:02 PM

By Susan Corneliuson, MHS, FACHE, Senior Manager, GE Healthcare Camden Group 

Pokémon GO!, a sensation in the gaming world, popularized location-based and augmented gaming reality but was initially released with mixed reviews. To some the game is little more than people running around catching virtual critters that appear in their coffee or on their neighbor’s lawn at 2:00 in the morning; to others it is a game of strategy in which they pulverize rival teams by taking control of gyms. In some ways, the Merit-Based Incentive Payment System ("MIPS") is also a game of strategy with physicians pitted against each other to see who will win the most points and take control of the healthcare dollar.

The Clinical Practice Improvement Activities (“CPIA”) performance category is the new addition to the Quality Payment Program under MIPS and with it also came mixed reviews. Adding incentives to improve the clinical practice environment, a category largely missing from past quality reporting programs, was seen as a benefit to the program. However, with over 90 activities to choose from there is concern about the cost to a practice of increasing or adding up to six new activities. 

Regardless of the potential draw-backs how do we become early adopters of CPIA and succeed in this new quality environment? Let’s think of CPIA as a game in which we have to catch three to six Pokémon (activities) out of 90 potential activities to win. In Pokémon Go there is a power hierarchy: those that are found everywhere (Caterpie, Weedle, Meowth) are worth less than those that are rarer (Venusaur, Blastoise, Dragonite). The less powerful Pokémon can be found everywhere so are easier to catch but can evolve into more powerful Pokémon. 

CPIA activities are also arranged in subcategories and assigned a weight of “high” or “medium,” earning 20 or 10 points each, respectively. Full credit achievement for this category is 60 points. Higher weighted activities are aligned with CMS national priorities and programs such as the Quality Innovation Network-Quality Improvement Organization (“QIN/QIO”) or the Comprehensive Primary Care Initiative (“CPCI”).  To be successful, select activities that are:

  • Easy wins such as activities that you are already doing
  • Simple to measure, track and report
  • Easily implemented with minimal effort or cost
  • Choose high-weighted activities for maximum points when possible. To achieve the highest potential score of 100 percent or 60 points, complete 3 high-weighted activities, 6 medium-weighted activities, or a combination thereof.  

Remember, 100 percent achievement on the CPIA category is attainable since measures are selected by the practice and there are no performance thresholds established for comparison. The six proposed subcategories with examples of high and medium weighted activities are show in the table below.

CLIA Sample List of Activities with High and Medium Weightings


Source: Centers for Medicare and Medicaid Services

Examples of activities that are weighted as high include:

  • Population Management: Use of a Qualified Clinical Data Registry (“QCDR”) to access practice patterns and treatment outcomes
  • Care Coordination: Participation in the CMS Transforming Clinical Practice Initiative.

Example of activities that are weighted as medium include:

  • Expanded Practice Access: Collection of patient experience and satisfaction data on access to care and development of an improvement plan
  • Beneficiary Engagement: Access to an enhanced patient portal that provides up to date information related to relevant chronic health conditions with bidirectional communication and interactive features.

There are a few activities that are more evolved than others and therefore earn a higher point value such as a patient-centered medical home (“PCMH”) or alternative payment models (“APM”). Participation in a PCMH model or comparable specialty medical home automatically qualifies for 60 points; full credit under the CPIA category. Participation in an APM that does not quality as an advanced payment model will automatically receive 30 points or 50 percent of the maximum point value. 

There are still a lot of unknowns under MIPS with the final rule expected November 1, 2016; however, preparing early and getting a jump start on your competitors will allow for more success down the road. MIPS is a zero sum game as no additional dollars are added to the budget which means that there will be winners and losers. CMS also anticipates that the first year will be the “easiest” under CPIA, with measures continuing to evolve over time. Just like Pokémon Go!, those that jump in early will be able to evolve more quickly and will have more potential to receive positive payment adjustments down the road. 

Please join GE Healthcare Camden Group on Thursday, October 20th for a complimentary, hour-long MACRA webinar focusing on legislative details as well the necessary tools to successfully navigate through the next phase of participation for the Quality Payment Program, MIPS, and APMs. Please click the button, below, to learn more and register:
Webinar, MACRA

Susan_Corneliuson.pngMs. Corneliuson is a senior manager with GE Healthcare Camden Group and has over 15 years of healthcare management experience. She specializes in physician integration strategies, practice assessments, operational improvement, care and workflow redesign, and compensation arrangements. She is the co-author of The Governance Institute’s signature publication for 2012, Payment Reform, Care Redesign, and the New Healthcare Delivery Organization. She has a strong background in physician practice management with experience in medical foundations, provider-based clinics, and specialty hospital settings. She may be reached at


Topics: Webinar, Susan Corneliuson, MACRA, MIPS, CPIA

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

Top 10 Actions to Take Now to Prepare for MACRA

Posted by Matthew Smith on Jul 29, 2016 10:11:44 AM

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

Most medical groups celebrated the repeal of the sustainable growthrate (“SGR”) and the associated cuts to the physician fee schedule. The SGR was replaced by the Medicare Access and CHIP Reauthorization Act (“MACRA”), a proposed CMS rule that is designed to encourage medical groups to pursue advanced payment models and accountable care.

MACRA replaces several Medicare reporting systems and creates two new programs: the Merit-Based Incentive Payment System (“MIPS”) and Advanced Payment Models (“APMs”). Both programs have pros and cons, but because they are currently scheduled to begin to measure performance on January 1, 2017, medical groups have little time to prepare.

Here are 10 actions your group should be taking now to prepare for MACRA.

  1. Determine your path. The MIPS program replaces the former EHR Incentive (Meaningful Use), Physician Quality Reporting System, and Value-based Payment Modifier programs with four measures of cost, quality, information technology (“IT”) use, and clinical practice improvement activities. How well your group performs on these measures compared to your peers will determine whether your Medicare payments are increased or cut by up to 9 percent by 2022. The APM path is for groups that are willing to take up- and down-side risk under new payment models, including select ACOs, medical homes, and bundled payments. APMs offer a 5 percent bonus payment.

    Many groups would rather avoid the reporting requirements, uncertainty, and potential payment reductions of MIPS. Unfortunately, qualifying for APM will be a challenge unless your group is already in a qualifying program – especially given the January 1, 2017 proposed start date. This aggressive timeline is one of the criticisms of MACRA, and CMS may push back the start date in the final rule. At this point, a vast majority (some projections are as high as 90 percent) of medical groups are expected to pursue MIPS, at least initially. Groups that start under MIPS can apply to move to APM in subsequent years.

  2.  Educate and engage your providers. Under the current performance based incentive programs, groups are rewarded for simply reporting data. If you start under MIPS, you will receive bonuses or pay cuts based on your actual performance against other groups. Active provider participation and engagement are imperative for improving your performance on the MIPS measures for cost, technology use, quality, and clinical practice performance. Start now by educating your providers on MACRA and the crucial role they play in your group’s success. Inform them that their scores will be published on Physician Compare for public consumption. Evaluate your physician compensation plan to ensure that incentives are aligned with your MACRA objectives.
  3. Assess your current technology. Health IT (“HIT”) is foundational to MACRA, which requires participants to use certified electronic health records technology (“CEHRT”). While the number of meaningful use measures has decreased, groups may have HIT challenges relating to interoperability and the exchange of information. Although vendors have made great advances in recent years, gaps still exist, and the development of new capabilities and analytics continues. To meet MACRA requirements specifically relating to the collecting, monitoring, and reporting measures and scores, groups may require additional IT capabilities beyond the CEHRT. Additionally, there is an increase in the use of Qualified Clinical Data Registries (“QCDR”) to collect clinical data to better manage the delivery of care, ultimately improving the quality.
  4. Know your quality measures. APMs typically have a prescribed set of measures based on the program whereas, under MIPs, providers have the option to select measures. However, MACRA does require that quality measures used in APMs be comparable to those used in MIPS. Knowing your quality measures, and if applicable, selecting the right measures, is key as your group’s performance will be determined based on how you compare to peers. It is important that you identify the measures applicable to your group, considering your provider specialty mix and patient population, and then create workflows to support the data capture of such measures. A good place to start is the Quality and Resource Use Report (“QRUR”) since this report compares your scores relative to your peers by calculating the standard deviations from the national mean for both quality and cost. There is also a high-risk bonus adjustment that is based on ICD-10 coding, so accurate diagnosis coding assignment is critical.
  5. Track provider performance. Monitoring your group’s performance at an individual provider level on a consistent basis is vital since every point matters. Groups need to track performance monthly and compare the values to peers as well as targets. Your exceptional performance scores do not guarantee success since your current performance is compared to future benchmarks, which are unknown at this time. Also, CMS has allocated millions of dollars to reward high performing providers who land above performance thresholds, so aiming high may get you additional dollars.
  6. Form a steering committee. Whether you pursue APM or MIPS, it will be important that your group is strategically aligned and that your efforts are coordinated. Much work will be necessary to ensure that your group has capabilities for measure selection, data capture and reporting, workflow analysis and/or development, training, and performance monitoring. A multidisciplinary steering committee consisting of physicians, management, IT, other providers, and staff can be a powerful way to align the group and to address the broad array of tasks. The steering committee will be charged with creating the MACRA strategy and a high level work plan. Members will oversee the plan’s progress, timeline adherence, and provide direction for resolution of any obstacles impacting the plan.
  7. Implement a change management program. Success under MACRA will require strategic and operational changes; change can be difficult to implement and even more difficult to maintain. Consider using a formal change management program that will combine a well-executed plan for change with the leadership needed to sustain that change over time. When executing tactical plans and projects, many groups focus solely on technical change strategies, while change management, like GE’s Change Acceleration Process (“CAP)” program, focuses on both the technical changes and change leadership. Change leadership is an essential, but often overlooked aspect of change strategy; it addresses the human or cultural component that provides the spark needed to activate change. Change leadership will align, mobilize and motivate all stakeholders with a shared vision to support the MACRA program, making success a reality.
  8. Consider partnership opportunities. APM and MIPS both present challenges, especially to smaller groups, that might be easier to overcome with partners. APMs require a group to take downside risk. Groups that do not have experience with risk or have a small patient population can benefit from joining an independent practice association (“IPA”), physician-hospital organization (“PHO”), clinically integrated network (“CIN”), or ACO that can provide care management capabilities, as well as spreading actuarial risk over a larger population. Success under MIPS will require technology resources, care management, and practice operational capabilities that may not be financially sustainable for small groups. Medical groups that have patient-centered medical home (“PCMH”) status receive full credit for achieving the MIPS Clinical Practice Improvement Activities measure, so groups should consider joining a network or hiring an MSO that can provide resources or capabilities to support a PCMH.
  9. Develop care management capabilities. Success under MACRA will require that groups deliver value by improving quality, outcomes, and patient experience while reducing costs. Use data to understand how your group performs today and where there are specific opportunities to improve. Then work with your physicians and staff to develop and implement care management capabilities that support higher performance. You should also look outside the walls of your group to partner with other providers, community resources, and your patients to more effectively manage the health of your population.
  10. Create a roadmap in 2016. MACRA reporting is scheduled to begin in January 2017; hence, the time is now to create a plan and roadmap. Understanding your group’s current challenges will be important as you develop your roadmap. Once you activate your plan, monitor your progress monthly and make any updates based on the final rule. Even if MACRA reporting is delayed, you will have a head start.

If groups take these 10 actions, they will be in a better position to transform the care that is delivered based on the Triple Aim of better care, better experience, and lower cost. And they will be rewarded financially under MACRA.


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: Medical Groups, Lucy Zielinski, Marc Mertz, MACRA, CAP, Change Acceleration Program

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

Posted by Matthew Smith on Jul 14, 2016 4:15:34 PM

By Nidhi Chaudhary, Consultant, GE Healthcare Camden Group

Healthcare delivery and its corresponding costs are changing due to recent industry trends. Value-based programs reimburse healthcare providers for the quality of care they provide to patients. To support this, the Medicare Access & CHIP Reauthorization Act of 2015 (“MACRA”) intends to reform Medicare payments to physicians over the next several years. MACRA has two pathways:

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

In order for practices to survive and compete in this value-based environment, specific initiatives must be deployed this year. 


Transitioning to the MACRA MIPS model

There are currently multiple quality and value programs for Medicare providers: Physician Quality Reporting Program ("PQRS"); Value-Based Payment Modifier; and the CMS EHR Incentive Program. 

MACRA streamlines those programs into MIPS and adds a fourth category called Clinical Practice Improvement Activities. Below is an example of MIPS Scoring for Year 1:


Challenges Faced by Physicians:

  • Uncertainties surrounding the shift from volume-to-value
  • Potential reduced reimbursement for services
  • Tracking of quality and cost management
  • Optimizing electronic health record (“EHR”)/registry use

Key MACRA questions for medical groups:

  • What does the current Quality and Resource Use Report (“QRUR”) tell you?
  • What is the implementation plan for 2016 and 2017?
  • What are the right measures that should be tracked and reported? Are workflow changes required?
  • What clinical practice improvement activities will be added?
  • How will the current infrastructure support the initiatives?
  • Is additional technology required?
  • How will the composite score be optimized?
  • Do we have adequate resources and education opportunities to be successful?

How can GE Healthcare Camden Group help organizations create and navigate a MACRA roadmap for 2017?

We help organizations:

  • Identify gaps and priorities by performing a MACRA readiness assessment
  • Help groups form and facilitate a steering committee with a shared vision
  • Integrate change management methodologies to ensure success
  • Create education and communication plans
  • Develop a tactical MACRA roadmap focusing on strategic and operational objectives   
See our sample work plan and timeline below:


If you want to get started with your own, personalized MACRA roadmap, click the button below and a GE Healthcare Camden Group MACRA expert will be in touch to start you on your way.



Ms. Chaudhary is a consultant with GE Healthcare CamdenGroup specializing in delivering strategies, working to provide more efficient and lean processes as well as coaching leaders and management. Ms. Chaudhary joined GE Healthcare in 2007 and has extensive experience in Regulatory Affairs and Quality Engineering pertaining to both medical and pharmaceutical devices. Ms.Chaudhary has provided support for strategic and business planning while working within the business and with the medical staff at multiple hospitals. She may be reached at


Topics: Value-Based Care, Payment Reform, Value-Based Contracting, Payment Models, MACRA, MIPS, Nidhi Chaudhary

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

Posted by Matthew Smith on Jun 6, 2016 1:14:09 PM
According to a May 2016 survey by the National Association of ACOs ("NAACOS"), more than half—56 percent—of accountable care organizations ("ACOs") in the Medicare Shared Savings Program ("MSSP") indicated they would leave the MSSP program if their ACOs were not eligible for the 5 percent Advanced Alternative Payment Model ("APM") bonus under the Medicare Access and CHIP Reauthorization Act ("MACRA").

A third of the ACOs said they would stay in the MSSP program even if deemed ineligible for the bonus, the NAACOS survey found.

The Alternative Payment Model ("APM") is one of two paths for participation in the quality improvement programs included in the MACRA legislation for eligible professionals; the other is the Merit-Based Incentive Payment System ("MIPS").

Currently, MSSP Track 1, a one-sided payment model, is not among the models that would qualify for the APM track—which CMS calls "Advanced APMs"—under the proposed MACRA rule; however, the MSSP Tracks 2 and 3, Next Generation, and Pioneer ACO programs, which all require downside risk, would qualify as APMs.

Approximately 411 MSSP ACOs, or 95 percent, participate in Track 1 of the program, according to April 2016 data from CMS.

All APM qualifying participants will receive a 5 percent lump sum bonus on their Medicare payments for 2019 through 2024. This bonus will be in addition to the incentive paid through existing contracts with the qualified APM (e.g., MSSP) demonstration program, etc.

Beginning in 2026, these ACOs will qualify for a 0.75 percent increase in their payments each year.

In other findings, the NAACOS survey also determined the following:

  • More than half of respondents (51 percent) describe their ongoing ACO operational costs as very significant;
  • The average total ACO operating costs for all respondents is $1.6 million per year, but the cost difference is significant between single or multi-ACOs, with single ACOs averaging just under $2 million and multi-ACOs averaging almost $1 million per year.
  • If required by CMS to take on downside risk, 43 percent said they would leave the MSSP program and about a third would stay (33 percent).
  • Over three quarters of the ACO respondents (84 percent) said they would be ready for downside risk within the next six years, with 44 percent of those even ready as soon as one to three years.

A PDF version of the full report may be downloaded here


Topics: ACO, MSSP, Accountable Care Organizations, MACRA, MIPS

Evolving Physician Reimbursement Structures: Moving the Medical Group to Value-Based Success

Posted by Matthew Smith on May 19, 2016 10:17:08 AM

By Cami Hawkins, MHA, Manager, GE Healthcare Camden Group (originally published in Journal of Healthcare Management, May-June, 2016)

Now that the Medicare Sustainable Growth Rate ("SGR") formula has been repealed, physicians and other providers must prepare for the Merit-Based Incentive Payment System ("MIPS"). This article addresses several important questions about evolving physician reimbursement structures and provides guidance on how to succeed under the new programs.

With the passage of the Medicare Access and CHIP Reauthorization Act, what changes can physicians expect with regard to payment incentive models?

Repeal the Medicare SGR formula and passage of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) are bringing about significant changes to the Medicare physician fee schedule and reimbursement methodology (Centers for Medicare and Medicaid Services ("CMS"), 2015). MACRA established annual positive or flat fee updates for ten years and implemented a two-track fee update thereafter. In addition, MACRA created MIPS and consolidated the current Medicare fee-for-service incentive initiatives. The law also provides a mechanism for physicians to participate in alternative payment methods, including the patient-centered medical home model and others to be defined. In repealing the SGR and passing the MACRA, Congress's intent was to move away from the fee-for-service payment methodology and toward a value-based payment system.

To continue reading, please download a PDF version of this article by clicking the button below. You will be directed immediately to the full article (no form required).

Value-Based Success


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, and hospital/physician integrations. She may be reached at

Topics: CMS, MACRA, Value-Based Payments, Cami Hawkins, MIPS, Physician Reimursement, Value-Based Success

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