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    Mollie Gelburd, JD

    The Medical Group Management Association’s most recent MGMA Stat poll asked healthcare leaders: Which track of MACRA will you participate in during 2020? The majority, 81%, answered “MIPS”, while 19% responded “Advanced APM”.

    The poll was conducted January 28, 2020, with 624 applicable responses.

    Four years into MACRA implementation, only 19% of medical group practices report participating in an alternative payment model (APM). Modest growth in APM participation leaves the vast majority of physicians participating in the Merit-based Incentive Payment System (MIPS), in which resources and time spent on reporting have outweighed dismal payment bonuses the past two years of the program. The bonus payment under MIPS, even for perfect performance, has been less than 2% for each payment year in which the Centers for Medicare & Medicaid Services (CMS) has released performance and payment results.

    To improve value-based payment reform and allow more practices to succeed, MGMA has laid out several priorities and technical suggestions for CMS.

    Focus on well-designed APMs

    A lag in APM development is partially to blame for low participation rates. However, simply rolling out more APMs won’t fix the growing pains of value-based payment reform. APMs must be well designed to attract participants and position them for success. This means models should have adequate and predictable payments, achievable targets for earning shared savings or financial bonuses for successful participation, appropriate risk adjustment, and metrics that only hold clinicians accountable for costs within their control. MGMA continues to advocate for more voluntary APMs for group practices of all specialties, as well as for better designed APMs with a more transparent process for developing and implementing them.

    Extend APM incentive payments

    The 5% lump-sum bonus offered to qualifying participants in eligible APMs is set to end in payment year 2024. To continue to incentivize value-based payment reform and support those transitioning into new care delivery and payment models, MGMA is urging Congress to extend the availability of the APM bonus well beyond 2024.

    Improve MIPS

    Payment adjustments under MIPS have been disappointing to date, which contributes to overall frustration with MACRA implementation.
    By design, MIPS is budget neutral, which means performance-based adjustments only improve and increase if more practices or clinicians receive penalties. One solution to this problem is to move more practices into APMs, in which practices can earn financial bonuses through successful participation in the model and/or through the 5% APM payment. But APM participation may not be a viable option for some medical group practices.

    To improve MIPS, MGMA recommends making the program more clinically relevant and less burdensome. A few of our specific advocacy priorities include reducing quality reporting requirements, resolving methodological concerns over cost measurement, updating the promoting interoperability category to allow group practices to use Certified EHR Technology (CEHRT) in more clinically relevant ways, and simplifying the overall scoring scheme.

    Provide positive Medicare payment updates

    As medical practices transition toward a value-based payment environment, fee-for-service will still account for a significant portion of Medicare payments and should be updated appropriately. Even if a payment system provides the right incentives, the system will not be sustainable for physicians to continue to provide high-value care if the underlying reimbursement rates are too low.

    MACRA provided stable, predictable updates to the Medicare Physician Fee Schedule but froze positive updates from 2020 through 2025. To ensure Medicare payment rates keep up with the cost of running a medical practice and inflation, MGMA supports replacing the scheduled payment freeze with a stable and positive update to the conversion factor.


    In the coming years, the path to value will continue to evolve. It is too soon to tell which payment models will prove sustainable and successful in the long run. Overhaul of the existing payment and care delivery system requires agility and innovative thinking. MGMA believes that certain changes can help group practices succeed and create a more meaningful program over time.

    Additional resources:

    Would you like to join our polling panel to voice your opinion on important practice management topics? MGMA Stat is a national poll that addresses practice management issues, the impact of new legislation and related topics. Participation is open to all healthcare leaders. Results of other polls and information on how to participate in MGMA Stat are available at:

    Written By

    Mollie Gelburd, JD

    Mollie Gelburd serves as a member liaison for MGMA Government Affairs and has broad expertise in the details of federal legislative and regulatory issues and their impact on group practices. She coordinates Association grassroots efforts and is a frequent speaker at MGMA state and national meetings. Previously, she worked as an attorney advisor at the Social Security Administration. Mollie earned a law degree from The Catholic University of America, Columbus School of Law and a bachelor's degree in political science from Radford University.

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