On April 16, 2015 an Act called the Medicare Access and CHIP Reauthorization Act (MACRA) was passed, which is a piece of history of bipartisan legislation. Eventually, on October 14, 2016 the Centers for Medicare & Medicaid Services, the department of Health and Human Services, and the regulatory agency which takes care implementing and putting into practice MACRA, gave out an ultimate rule with a comment duration putting into practice the provisions of MACRA. MACRA revokes the highly denounced Sustainable Growth Rate Formula together with its schedule for Medicare Physician Fee (MPF) cuts, substituting it with the Quality Payment Program, which is a new model that focuses on cost measurement and quality, as well as payment and reporting adjustments. Physicians and their assistants, clinical nurse specialists, nurse practitioners, and certified registered nurse anesthetics are all part of the eligible clinicians indicated in Medicare Part B and their QPP includes the tracks of payment for: (Gaylis & Gaylis, 2017).
The Merit-based Incentive Payment System.

The physicians who are not involved in any form of APM will automatically be on the track of MIPS. Some will be exempted if they fail to meet the “low volume threshold” of the MIPS which can be an undefined least number of patients, the permitted charges for a performance duration, services or by appearing in the Medicare participation of their first annual period. From 2019, MIPS will put into consolidation the Value-Based Payment Modifier (VBPM), Meaningful Use (MU), and Physician Quality Reporting System (PQRS) programs into one new program, which will also be inclusive of a new classification of performance measures known as “Clinical Practice Improvement Activities” (CPIA). The compound score of MIPS will be determined by the performance of the physician in the four areas. This score is the one to determine the payments adjustments annually. The law dictates that CPIA which is defined more in rule-making, will be the one to measure things like patient safety, care coordination, access, patient management, and population health management. It is interesting that ‘certified’ PCMHs will obtain all the points for the classification of CPIA. Although the term PCMH (patient-centered medical homes) has not been defined yet, this will be the only time it will be used (Mullins, 2016).

In order to determine how Medicare will modify the payments of the physician annually, each of their scores will be collated with a performance threshold. The payments of only those scoring at the threshold directly will not be adjusted. Both upward and downward adjustments in payments will be conducted as claimed by an individual. The people whose score will go above the threshold may get a standard adjustment of up to three times according to their score. Those physicians whose score is in the top 25% may also qualify to have their payments adjusted in...…they make up incentives for providers to bring up more services like office visits, imaging, tests, and hospitalizations and mostly the services which are costly because a percentage given to higher prices leads to a greater increase in revenue (McWilliams, 2017).

Impact on Stakeholders

Stakeholders may want to know whether the process of attribution matches clinicians and patients appropriately or whether the use of resource and quality is relevant, and whether the resource and quality standards are modified to fit the patient's’ risk and complexity, inclusive of the socioeconomic status (Deloitte Development, 2016).

It has been debated a lot on whether the providers should take the increased costs of getting a better performance on quality measures for patients at a higher risk specifically when the higher risks are from the social factors. It doesn’t matter how people view this debate, because adjustment of risks in the MIPS partially accounts for differences in the risk of the patients will effectively move the resources to providers taking care of low risk patients from the ones taking care of high-risk patients, whether the providers carry the increased costs in enhancing quality for patients at a high-risk or if they get penalties from not acting that way. Risk adjustment which is not adequate also inaugurate incentives for the providers to draw patients who are at a low risk, and shifting their attention and resources away from enhancing the existing…