2016 ACS Governors Survey:
MACRA: Are surgeons ready?
Juan C. Paramo, MD, FACS;
Editor’s note: The American College of Surgeons
(ACS) Board of Governors (B/G) has conducted an
annual survey of its members for more than 20
years. The purpose of the survey is to provide a
means of communicating the Governors’ concerns to the College leadership. The 2016 ACS
Governors Survey, conducted in August 2016, had
an 84 percent (230/274) response rate.
The following article focuses on surgeons’ perceptions of the payment reforms that are being
implemented through the Medicare Access and
CHIP (Children’s Health Insurance Program) Reauthorization Act (MACRA).
After more than a decade and a half of debate, Con- gress repealed the flawed sustainable growth rate (SGR) formula that had been used to calculate
Medicare reimbursement for physician services with
the passage of MACRA in 2015. This legislation replaces the SGR with the Quality Payment Program (QPP),
which is designed to encourage and reward the provision of value-based care. MACRA’s emphasis on quality
is appealing to surgeons, especially Fellows of the ACS,
which was founded for purposes of improving patient
care and setting standards for the quality of care given
Physicians may participate in the QPP either through
participation in an Advanced Alternative Payment Model
(APM) or the Merit-based Incentive Payment System
(MIPS). Because APMs for surgery are largely still in development, most participating surgeons will use MIPS for
Medicare reimbursement—at least initially—but likely
will need to conform with APMs as they are implemented
to achieve proper reimbursement.
MIPS has four components, three of which are analogous to existing Centers for Medicare & Medicaid Services
(CMS) quality programs: Quality, which is similar to the
Physician Quality Reporting System (PQRS); Advancing
Care Information (ACI), which builds on the Electronic
Health Record (EHR) Incentive Program (also known as
meaningful use); and Cost, which is similar to the Value-based Modifier (VM). The fourth component, Clinical
Practice Improvement Activities (IA), is new.