The American College of Physicians Statement on the MACRA Final Rule

Attributable to:
Nitin S. Damle, MD, MS, MACP
President, American College of Physicians (ACP)

October 14, 2016

The Centers for Medicare and Medicaid Services (CMS) today released the Medicare Access and CHIP Reauthorization Act (MACRA) Final Rule, with the aim of evolving our payment system to one that recognizes and incentivizes quality and value rather than volume.  An initial ACP review of the nearly 2,500-page document reveals that CMS incorporated numerous recommendations made by ACP in order to simplify and reduce burdens on physicians and their practices, including:

  • Pick Your Pace has been implemented in a manner that provides flexible options for the first performance period, thus allowing for a transition period that will hold physicians harmless if they are able to report a minimum amount of 2017 data to Medicare (for example, one quality measure or one improvement activity for any point in 2017).
  • Resource use (or cost) has been adjusted downward to 0 percent—from the 10 percent that had been proposed for the first performance period.
  • The low-volume threshold for participation in MIPS has been raised to less than $30,000 in Medicare Fee-for-Service (FFS) revenue OR less than or equal to 100 Medicare patients, which will help provide a better safety net for small practices.
  • There are now expanded options for Patient-Centered Medical Homes (PCMHs) to get full credit for clinical practice improvement activities (CPIA) under MIPS.
  • A new Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO) track is going to be established, called the Medicare ACO Track 1 Plus (1+), which could help bridge the transition to taking on two-sided risk for current track 1 Medicare ACOs.

ACP will review the rule in greater detail, but expects to be asking for improvements in several areas.  In particular, we would like to see CMS provide multiple pathways for medical homes, beyond CPC+ within the advanced APM pathway.

ACP is committed to working with CMS to ensure that the MACRA program truly results in a healthcare system that puts patients, families, and the relationship of patients and families with their physicians at the forefront.

ACP will provide a more in-depth analysis of the MACRA Final Rule in the coming days.


The American College of Physicians is the largest medical specialty organization and the second-largest physician group in the United States. ACP members include 148,000 internal medicine physicians (internists), related subspecialists, and medical students. Internal medicine physicians are specialists who apply scientific knowledge and clinical expertise to the diagnosis, treatment, and compassionate care of adults across the spectrum from health to complex illness. Follow ACP on Twitter and Facebook.

Contact: David Kinsman, (202) 261-4554,