Is the Quality Payment Program the most disruptive feature of MACRA?

Near unanimous bipartisan support from Congress gave the Medicare Access and CHIP Reauthorization Act (MACRA) its first wave of attention in 2015.

But how it plans to fundamentally shift the way government programs measure and pay for healthcare services is likely to be what will make headlines going forward.


Specifically, MACRA seeks to move the Medicare program away from payments based on volume of services delivered and towards payments based on the quality and efficiency of services delivered. MACRA offers two reimbursement pathways for this change, both of which fall under the umbrella of the newly-created Quality Payment Program (QPP). The first pathway, the Merit-Based Incentive Payment System (MIPS), will adjust traditional, fee-for-service payments based on metrics like quality and resource use. Under the second pathway, providers may opt to participate in Advanced Alternative Payment Models, which include programs like Accountable Care Organizations, Patient-Centered Medical Homes, and, eventually, Bundled Payment Models. To incentivize providers to move into these payment models, those with a sufficient level of participation in these APMs will receive an annual 5% lump sum bonus payment and will be exempt from MIPS reporting and payment adjustments.

If successful, the Quality Payment Program could significantly reframe delivery and reimbursement of Medicare services in the United States. The Centers for Medicare and Medicaid Services (CMS) estimates that MACRA will reform payments for over 600,000 clinicians across the country. This will undoubtedly be a hugely disruptive change for many of these physicians, with many clinicians already vocal about their disapproval. But is it the most disruptive piece of MACRA?

More disruption

It’s another provision of MACRA,  less well-known, but potentially hugely disruptive, that could affect even more clinicians and beneficiaries. In fact, this provision is likely to produce a logistical challenge of unprecedented magnitude: MACRA also requires that the federal government issue new Medicare cards to every beneficiary, and that all federal and private health information systems be ready to process newly-generated Medicare identification numbers in 2018. This provision, the New Medicare Card initiative (formerly called the “Social Security Number Removal Initiative”), is vital and potentially very complicated.

Current Medicare patient identifiers

Currently, Medicare uses social security-based Health Insurance Claim Numbers on Medicare cards to identify beneficiaries. Given the obvious security problems with this method, MACRA gave CMS four years to remove Social Security Numbers from Medicare cards, something that happened long ago for identifiers like driver’s licenses and private insurance cards. Social security-based Health Insurance Claim Numbers will be replaced by Medicare Beneficiary Identifiers (MBIs).

The change will require CMS to replace Medicare cards for 150 million beneficiaries, 60 million of whom are living, and 90 million of whom are deceased. To use these new identifiers, CMS will have to replace 75 legacy information systems that are used to process claims, both within CMS and for its contractors. Health plans will also have to ensure that their information systems can handle the new 11-digit number. And like health plans, providers must also ensure their electronic health records, billing systems, other health information technology, and staff are ready for the change.

These new Medicare cards will roughly double the typical number of insurance identification changes providers experience annually, creating a prime environment for patient identification mistakes to be made at registration.

Preparing for MACRA changes
To learn more about the New Medicare Card initiative and to understand potential impacts on patient identification, download our whitepaper, The challenges of MACRA – and how biometric patient identification can help.