MACRA, MIPS, and Patient Engagement



So what exactly is MACRA?

In 2016, Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA). In essence, under MACRA, providers will be paid based on the quality and effectiveness of the care they provide. As the program grows, payments to the provide will ultimately be based on value – not on volume – like the current fee-for-service system. This new value-based payment program will be based on 2 new reimbursement models:

  1. MIPS (Merit-based Incentive Payment System). Eligible providers will be measured and paid based on: quality, resource use, clinical practice improvement, and meaningful use of certified EHR (electronic health record) technology. The MIPS composite score will help determine positive, negative, or neutral adjustments to their base rate of their Medicare Part B payments.

  2. APMs (Alternative Payment Models). Most providers who participate in APMs will also be subject to MIPS, but will additionally receive more favorable scoring – with correspondingly higher reimbursement rates. These APM models act further from the fee-for-service payment model and work to tie payment to value and focus on better care, smarter spending and healthier people.

So what does this all have to do with Patient Engagement?

CMS has added in patient engagement requirements to MIPS through Advancing Care Information, one of the four components contributing to the MIPS score. Starting in 2017, eligible providers were required to meet the following criteria:

  • Allow one unique patient view, download, and transmit capabilities with their health data

  • Allow one unique patient access to their health data via an application programming interface (API)

  • Supply patient-specific educational materials to one unique patient

  • Extend one unique patient view, download, and transmit capabilities, with that patient then transmitting the data to a third-party provider

  • Send or answer at least one secure direct message with one unique patient

  • Collect patient-generated health data from one unique patient

  • Send or receive a summary of care from a third-party provider for one unique patient


More than ever, a focus on engaging the patients is utmost important. Given the link between reimbursement and successful patient engagement, providers must encourage patients to use portals and interact with their health information. However, as we have discussed previously, the have been several obstacles in successfully utilizing these methods. A focus is now on more simple technology options that patients can access without the startup and maintenance effort required of previously trialed portals. StreaMD is dedicated to researching and providing these opportunities and services.



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Kevin Campbell