The differences between SGR and Medicare Provider Payment Modernization Act of 2015
| SGR | MACRA | |
|---|---|---|
| Annual Medicare Update for Physician Services |
| Annual update of: (0% January through June 2015) (0.5% July 2015 through 2019) (0% in 2020 through 2025) (2026 and beyond: 1% for APM participants; 0.5% for all others) |
| Pay for Performance/Quality Reporting Programs | PQRS+MU+VBM Maximum total penalties
| MIPS maximum penalties and bonuses
MIPS quality standards. Extra bonus 2019–2024: up to 10% for exceptional performance (up to $500 million/year). MIPS has more accurate assessment, scoring, flexibility, predictability than under PQRS, MU, or VBM. MIPS abandons current VBM ‘tournament’ model (requiring penalties to equal bonuses) |
| EHR MU | No clear timeline or enforcement tools to achieve interoperability | MU measures count 25% in MIPS. Interoperability is a goal by 2018; Secretary may adjust penalties and/or decertify EHRs if this is not achieved |
| APMs | No guaranteed payment update or bonus for physician participation in medical homes, ACOs, or other existing APMs. Limited support for physicians to develop new payment models | 5% Bonus payment for 2019–2024 for successful participation in eligible models. APMs must bear more than nominal risk, or be a qualifying medical home. Physicians can propose new APMs. $20 Million/year (2016–2020) in technical assistance for small practices to develop new models or participate in MIPS |
| Quality Measure Development Funding | None | $15 million/year (2015–2019) for measure development; $75 million total. Excess available through FY 2022 |
| Physician data access | Data provided by CMS through physician feedback program. No requirements on timeliness | Requires CMS to provide timely (such as quarterly) feedback reports at individual physician level |
| Physician claims data | Physician 2012 claims data released by CMS. QEs authorized to do public reports using the data | Establishes an annual release of physician data with no explicit safeguards. Expands QE authority to provide non-public reports and data with explicit protections. Provides data to QCDRs |
| Standard of Care Protection Act | No protections | Included. Quality program standards do not set standard of care in medical liability actions |
| Opting out of Medicare | Renew status every 2 years or face serious consequences | Status continues indefinitely; no need to renew every 2 years |
| CCM services | Medicare started paying for CCM services in 2015, but could end those payments in the future | Permanently requires Medicare to pay for care management of patients with chronic health problems, without requiring an annual wellness visit or initial preventive physical examination |
Reprinted with permission Manchikanti et al.1
ACOs, accountable care organizations; APM, alternative payment model; CCM, chronic care management; CHIP, Children's Health Insurance Program; CMS, Center for Medicare and Medicaid Services; EHR, electronic health record; MACRA, Medicare Access and CHIP Reauthorization Act; MIPS, Merit-based Incentive Payment System; MU, Meaningful Use; PQRS, Physician Quality Reporting System; QCDRs, Qualified Clinical Data Registries; QE, qualified entities; SGR, sustainable growth rate; VBM, value-based model.