What UPG Providers Need to Know about MACRA

Last month we shared the following 4 facts regarding MACRA, relevant to UPG providers:

  1. Under MACRA, there are two reimbursement structures: MIPS (Merit Based Incentive Payment System) and APMs (Alternative Payment Models). Because we are in a fee for service environment, we qualify for the MIPS structure —  not APMs — as the APM track requires that participating organizations bear substantial risk (among other qualifications) and UPG does not currently have any at-risk contracts.
  2. All UPG clinicians benefit from the fact that UPG is a large organization with over 1,000 providers. We report our performance measures as a group practice, and our MIPS Composite Performance Score is calculated as such. Providers most at risk for penalization under MIPS regulations are solo practitioners (primary care and specialists) and small groups. UPG providers do not face such risk.
  3. While penalization isn’t an immediate concern, as we look to the future and the MIPS requirements become more stringent we will need to focus efforts on performance measures:
      • Quality
      • Cost/Resource Use
      • Clinical Improvement Activities
      • Advancing Care Information
  4. Physicians can contribute individually to group performance by:
      • Thorough documentation of patient care
      • Diligent management of screening, managing and monitoring patient conditions
      • Providing input as necessary with regard to EHR system technology


  • The MIPS reporting deadline for Web Interface reporting of Quality measures for the 2017 reporting year is March 16, 2018. UPG currently has staff members working to abstract pertinent data from individual patient records. This abstraction involves reviewing a minimum of 3,472 specific Medicare beneficiary charts for reporting particular data elements related to 14 quality measures. Once the data is abstracted, it is uploaded to the CMS Quality Payment Program website and added to our score calculation for the MIPS program.
  • Data relating to Advancing Care Information and Clinical Improvement Activities has also been entered into the portal and will contribute to UPG’s overall score in the program.


  • How are scores calculated?
    •  Each performance measure category has a different weight, and relative weighting will change over time. Together, these determine the MIPS Composite Performance Score (CPS).
    • Composite Performance Scores are compared to a Performance Threshold (PT) to be determined by CMS each year.

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  • How are penalties and bonuses determined?
    • Non-participation results in a 4% penalty for the 2017 reporting year. Partial to full participation results in increasing bonus potential.
    • UPG is submitting a full year of 2017 data.

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    • Participants that fall above the PT receive bonuses (i.e. a positive payment adjustment to their future Medicare Part B reimbursement rate). Those that fall below the PT face penalties (i.e. a negative payment adjustment).
    • The further the Composite Performance Score is above or below the PT,the potential for reward or penalty increases.


  • What results can UPG providers expect?
    • UPG providers can expect to successfully exceed the PT this reporting year, but specifics cannot be accurately estimated as they are based on comparative performance.

This article provides some history and context for MACRA. We hope that you find it informative. As you read, please keep in mind that we qualify for MIPS structure – not APMs.

Please don’t hesitate to reach out with any questions or concerns, or if you seek further clarification: UPGfeedback@virginia.edu


  1. sps2s@virginia.edu says:

    It is worth noting that this year all points for Clinical Improvement Activities will be awarded to the UPG team based on the success of the Department of Family Medicine in reaching and maintaining NCQA PCMH level 3 designation. That’s the beauty of a group practice.

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