American College Of Surgeons - Inspiring Quality: Highest Standards, Better Outcomes

Medicare Physician Payment

American College of Surgeons response to Centers for Medicare and Medicaid Services request for information related to the Medicare Access and CHIP Reauthorization Act (MACRA)

Key Provisions of MACRA

  • Full and permanent repeal of the broken sustainable growth rate (SGR) formula used to calculate Medicare physician payments
  • Annual positive updates of 0.5 percent from July 2015 to 2019
  • Maintenance of fee-for-service as a payment option
  • Elimination of current-law penalties from the existing quality programs, such as the Physician Quality Reporting System (PQRS), Electronic Health Record (EHR) Meaningful-Use Program and the Value-Based Modifier (VBM) Program in 2019, and combining these programs into a single Merit-Based Incentive Payment System (MIPS). The merit-based program would be based on physicians achieving a threshold, or benchmark. Such a system makes it possible for all providers who reach these quality benchmarks to achieve positive incentives or payment updates
  • Incentives to move into advanced alternative-payment models (APMs), including 5 percent bonus payments from 2019 to 2024, and exemption from some other reporting requirements
  • Inclusion of appropriate pathways for surgeons to develop, test, and participate in APMs, such as the Clinical Affinity Groups (CAGs) in ACS’s Value-Based Update (VBU) proposal
  • Prohibits CMS from implementing its plan to transition 10- and 90-day global payments to 0-day global payments
  • Clarification that no standard or guideline created under federal health programs shall be construed as setting the standard of care for purposes of malpractice claims.

Frequently Asked Questions


Statements Before Congress

What Is Sequestration?

Medicare Participation Status Information

Stark Law

Preservation of the in-office ancillary services exception (IOASE) to the “Stark” law and rejection of a proposal to restrict the IOASE for advanced imaging, radiation therapy, anatomic pathology, and physical therapy. View letters to the following congressional committees: Energy & Commerce, Finance, and Ways & Means.

The ACS supports the halt legislation that may provide audiologists with unlimited direct access to Medicare patients without a physician referral. H.R. 4035 and S. 2046 inappropriately provides audiologists with unlimited direct access to Medicare patients without a physician referral.