MACRA, MIPS, and APMS: Making Sense of Alphabet Soup

College leaders give a rundown on the new legislation and what to do about it.


At the Crossroads of Radiology, the word “change” is on everyone’s tongues. Driving part of that change is the MACRA legislation, which repealed the much maligned SGR methodology.

And with MACRA comes a whole other group of acronyms, from MIPS to APMs. During the session “How to Be a Successful Radiologist,” Chris Sherin, director of congressional affairs at the College, and Richard Duszak Jr., MD, FACR, gave us a rundown on what these acronyms mean.


First of all, what is MACRA? The Medicare Access and CHIP Reauthorization Act mandates fixed yearly increases of .5 percent to the physician fee schedule until 2019. Its goal is to implement a new system of incentive payments based on quality metrics and risk sharing. Although fee for service will still continue, those practices or physicians that fail to perform well on the specific quality metrics will face penalties that could put a definite dent in their reimbursement.
MACRA asks physicians to participate in two kinds of payment systems:


MIPS, or the Merit-Based Incentive Payment System, is essentially a modified fee-for-service program, said Sherin. MIPS streamlines incentive programs such as PQRS, Meaningful Use, and other clinical improvement initiatives into one program. This is the area most radiologists will fall under, according to Duszak.

Beginning in 2019, each physician under MIPS will earn a composite score from 0 to 100 based on the performance in these programs. The physician’s composite score will determine whether the physician receives a bonus or penalty. This score will be based on the physician’s performance in 2017.
A threshold will be created based upon the mean or median of the composite scores of all the physicians participating. Physicians whose scores fall below the threshold will be penalized. Those whose scores fall above receive an incentive payment. These penalties and incentives will begin at plus or minus 4 percent and gradually rise to plus or minus 9 percent by 2022.

Sherin updated attendees on some of the new facets of MIPS, including the fact that those considered non-patient-facing physicians will receive consideration and greater flexibility under MIPS due to their unique situation compared to physicians who see multiple patients a day. A non-patient-facing physician is one who encounter 25 or fewer patient-facing encounters during one year.


APMs, or alternative payment models, are the other track physicians can participate in under MACRA. APMs are a form of population-based care. An entire group of physicians assumes an amount of financial risk for the continued care of a patient, based on factors such as whether the patient must be readmitted or not. Accountable care organizations are an example of a working APM. And although radiologists may not fall directly under these programs, Duszak noted that APMs represent a great opportunity for radiologists to partner with their administrators to provide greater value in care.

What to Do

How can you prepare for these value-based payments? Duszak had a few tips:

-Take advantage of your tools: the Neiman Health Policy Institute® has a variety of tools, such as the ICE-T app and the Data Almanac, to help you understand imaging and utilization trends.

-Make use of structured reporting: According to Duszak, it’s an easy way to implement value into your work.

-Participate in programs offered by the ACR, including the R-SCAN initiative, which offers physicians an easy way to connect with referring physicians and implement value-based practices. You can also participate in registries that contribute information about imaging use such as those housed under NRDR®.

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