As the largest change in Medicare physician payment since the Sustainable Growth Rate (SGR) formula, the Medicare Access and CHIP Reauthorization Act (MACRA) will impact over 800,000 clinicians and reallocate in excess of $1.2 billion in payments for bonuses and penalties in its first year. The 962 page proposed rule for its implementation generated thousands of pages of comments, with close to 4,000 organizations and individuals submitting formal comment letters to the Centers for Medicare and Medicaid Services (CMS).

The major focus of the proposed rule is on the two new methodologies for physician payments:

• the Merit-Based Incentive Payment System (MIPS), which adjusts fee-for-service (FFS) payments based on a blended measure of quality and cost which entails value
• Advanced alternative payment models (APMs) that shift from FFS payment.

How these payment methodologies of the legislation are implemented (and when) will have a seismic shift on clinician payment as well as the evolution in the structure of health care organizations, the way that they deliver care, and revenue and risk sharing.More info Steven Lash.