1. Understanding the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)

2. What Did MACRA Do? Repealed the flawed Sustainable Growth Rate (SGR) Established framework for moving Medicare from a VOLUME to a VALUE-BASED system

3. Encourage Alternative Payment Model participation Improve Medicare quality reporting systems MACRA Recognize quality based on clinically, relevant evidence- based measures Improved Patient Experience Reducing the Cost of Care Improving Population Health

4. Broadly Written Directions, Implementation Details Unclear What About the Details of the Law? CMS released first proposed regulations in April 2016 – currently open for public comment Repeal not likely

5. Changing the Payment Landscape Pre-MACRA 21% payment cut in 2015, continued uncertainty Separate quality reporting programs Incentives for alternative payment model participation mainly from savings Post-MACRA Eliminates SGR; implements stable payment increases Streamlined quality reporting program Incentives for alternative payment model participation built into payment system

6. MACRA Payment Adjustments 20152016201720182019202020212022+ PQRS+VM+MU Adjustments (combined) ~+ 5% 3.5% TBD - 6% TBD -9% TBD -10% or more PQRS+Value Modifier+Meaningful Use Replaced by MIPS MIPS Bonus/Penalty (max) +4% * -4% +5% * -5% +7% * -7% +9% * -9% APM Bonus ^ +5% * May be increased by up to 3 times to incentivize performance $500 mil funding for bonuses allocated through 2024 ^ APM Bonus funded through 2024 Benchmark Neutral Adjustment High Performance Positive Adjustment Low Performance Negative Adjustment PQRS+Value Modifier+Meaningful Use

7. Small Practice Assistance $20 mil allocated to help practices of ≤ 15, rural, and underserved areas Allow “virtual groups” All Eligible Professionals will need to receive quality and resource use feedback at least quarterly

8. 2016 Medicare Physician Fee Schedule Defining MIPS-exempt professionals based on “low volume threshold” Identifying activities to meet the Clinical Practice Improvement component of MIPS Designing the elements of a physician-focused payment model

9. Considerations Increased awareness between payment and quality Increased focus on alternative payment models Opportunities to impact quality improvement Value of registries and meaningful measures How will ACC ensure members have the resources to meet new requirements?

10. Recognizing NCDR Participation NCDR registries as a way to meet reporting requirements under three MIPS components: Quality Advancing care information Clinical practice improvement activities ACC staff is working towards creating specific NCDR Registry- based solutions to the performance Improvement participation requirement.

11. More information is available on the ACC’s online MACRA hub at www.ACC.org/MACRA Updates are provided via the hub and through the ACC’s Advocate newsletter.