MACRA and Value-Based Payment Models: Regulatory Changes and Reimbursement Implications

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Overview / Abstract:

MACRA, MIPS, and APMs...Oh My! Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program. Through the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), Congress streamlined and improved these programs into one new Merit-based Incentive Payment System (MIPS). Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS.

Although only in a proposed state now, the rule would improve the relevance and depth of Medicare's value and quality-based payments and increase clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide. MIPS allows Medicare clinicians to be paid for providing high quality, efficient care through success in specific performance categories.

Alternatively, clinicians who take a further step towards care transformation--participating to a sufficient extent in Advanced Alternative Payment Models (APMs)--would be exempt from MIPS payment adjustments and would qualify for a Medicare Part B incentive payment.

Discover how these changes will impact your practice, hospital, or health system.

At the conclusion of the activity, attendees will be able to:
• Discuss the MIPS and Advance APM tracks of the MACRA Quality Payment Program "QPP"
• Explain new CMS payment models and the trajectory for 2018 and beyond
• Appreciate how physicians and leading health systems are thinking about non-FFS based payment models
• Examine how 'variable reimbursement' is likely to impact physician reimbursement and compensation moving forward


Mar 15, 2020


Nurse Practitioner , Nursing CNE, Physician CME, Physician Assistant CME




$29 to $42

Credits / Hours



ACCME, Florida Board of Nursing

Presenters / Authors / Faculty

Nathan Bays, JD is the Managing Director of the Cain Brothers' Health Systems Mergers and Acquisitions Group. Mr. Bays' responsibilities focus on strategic transaction advisory engagements with health systems, academic medical centers, community hospitals, and physician networks and groups. Nathan also serves as Senior Policy Advisor to The Health Management Academy.

Sponsors / Supporters / Grant Providers


Keywords / Search Terms

American Board of Quality Assurance and Utilization Review Physicians (ABQAURP)

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