MACRA: Are You Ready for January 2017?

Dr. Jeffrey D. Lehrman
Foot and Ankle Specialists of Delaware County


MACRA begins January 1, 2017. It is not being delayed. Under MACRA, all doctors will choose to participate via either MIPS (Merit Based Incentive Payment System) or an APM (Alternative Payment Model). An APM will not be an option for most or any podiatrists.

All doctors participating in MIPS will achieve a 2017 MIPS score of between 0 and 100. Their 2019 Medicare Part B Physician Fee Schedule will be adjusted based on their 2017 MIPS score. This adjustment can be as low as negative 4% for lower scores and as high as positive 4% for higher scores.

With some exceptions, this is mostly a budget-neutral program. That means there will be a mostly direct relationship between the amount of money lost in negative adjustments and the amount of money available in positive adjustments.

The MIPS score will be calculated based on four categories:

  • Quality
  • Advancing Care Information
  • Clinical Practice Improvement Activities
  • Cost of the Care You Provide

Quality replaces what we currently know as PQRS and mirrors the current program closely.

Advancing Care Information replaces what we currently know as Meaningful Use and has many of the same objectives as Meaningful Use.

Medical FinanceDoctors will be able to earn MIPS points in the Clinical Practice Improvement Activities category by participating in things such as remote monitoring, telehealth, reporting data to a qualified clinical data registry, and offering same day appointments, among other options.

The Cost of the Care You Provide component will be calculated by claims review, so no additional reporting will be required. In this category, higher scores will be earned with more efficient resource use.

In early September, CMS announced flexibility as far as available levels of participation in the Quality Payment Program for 2017. There is an option which makes it very easy to avoid a negative payment adjustment. We will cover MACRA in great detail, including these recently announced changes, during the AAPPM Fall Symposium November 10 – November 13 in San Antonio, TX. Join us and alleviate all of your MACRA worries!


Dr. Lehrman is on the APMA Coding Committee, serves as an expert panelist on, and is a Fellow of the American Academy of Podiatric Practice Management (AAPPM). Follow him on Twitter @DrLehrman.