Medicare Access and CHIP Reauthorization Act

Background

With the 2015 Medicare Access and CHIP Reauthorization Act, Congress continued the Affordable Care Act’s move toward quality over quantity of health care delivery. MACRA also eliminated the sustainable growth rate, preserved fee-for-service and consolidated several quality-reporting programs into the Merit-Based Incentive Payment System. In addition to establishing MIPS, the law created several new voluntary models that would change the way CMS pays physicians – the biggest change to Medicare since 1997. These alternative payment models can include accountable care organizations, patient-centered medical homes and bundled payments.

• Providers who successfully participate in an "advanced" alternative payment model would be exempt from MIPS and qualify for bonus payments.
• However, CMS proposes strict criteria for advanced alternative payment model.
• The Academy expects most ophthalmologists to choose MIPS rather than an alternative payment model, due to the limited number of payment models that meet the proposed criteria for advanced models, and the high participation thresholds for providers who choose this option. 

Academy position

The Academy recognizes that MACRA is not a perfect policy. For example, there are only a limited number of APMs that apply to ophthalmology, and there are still some things about the Physician Quality Reporting System, value-based modifier and meaningful use that we must continue working to improve. To roll these programs into MIPS without addressing underlying problems would hurt physicians.  

What we’re doing

Years of Academy advocacy with other organization came to fruition in MACRA’s elimination of the flawed SGR formula. The Academy continues to work closely with the other physician organizations on implementation of MACRA’s other components, especially the MIPS program. The Academy is pressing to ensure that CMS addresses existing issues with the quality-reporting programs that will comprise MIPS. The Academy will advocate for future legislation to improve or modify MACRA and how physicians are reimbursed by Medicare.

Other Resources

• How to succeed amid Medicare's transformation – Academy guide for physicians and administrators
• Academy analysis of the 2018 Quality Payment Program final rule
• APM Provisions in Medicare Access and CHIP Reauthorization Act [PDF 916k] – AMA guide

What you can do

• Help ensure zero penalties for ophthalmology in 2019.
• Become a Congressional A.dvocate, a national network of ophthalmologists who commit to communicating with their members of Congress.
• Participate in Congressional Advocacy Day, a unique opportunity to lobby members of Congress in their Capitol Hill office.