MACRA and the Promise of Better Patient/Family Engagement in Post-SGR World

The story of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) actually begins in the previous millennium. In 1997, when the Congress passed the Balanced Budget Act, it ushered in the era of the Sustainable Growth Rate (SGR) formula. In theory, the SGR payment adjustment would raise or lower physician reimbursement each year based on spending relative to the target SGR. The caveat, however, was that Congress had the authority to suspend or adjust this benchmark, a “patch” that they regularly deployed through a “doc fix” for nearly two decades.

When President Obama signed the bipartisan MACRA into law in April 2015, it did a lot more than simply repeal SGR. Congress designed MACRA to modernize Medicare physician payment and reward better healthcare value in several ways. Thus, MACRA has many important implications for the future of health care delivery in the United States, including advancing the role of patient engagement throughout healthcare.

We’ve distilled MACRA’s patient engagement elements into four main categories:

1.  Qualified Clinical Practice Improvement Activities for the Merit-based Incentive Payment System (MIPS).

In order to help shift physician payments along the spectrum from volume to value, MACRA established the MIPS to hold accountable providers who are not practicing in a qualified alternative payment model (APM).