Medicare Access and CHIP Reauthorization Act (MACRA) establishes a new pay-for-performance program that’s focused on quality, value, and accountability. The law was signed on April 16, 2015. The Centers for Medicare and Medicaid Services (CMS) stated that MACRA enacts a new payment framework called the Quality Payment Program that rewards health care providers for giving better care instead of more service.
MACRA combines parts of the Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record (EHR) incentive program into one single program called the Merit-based Incentive Payment System, or “MIPS”.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ended the Sustainable Growth Rate (SGR) formula, which would have significantly cut payment rates for participating Medicare clinicians. MACRA requires us to implement an incentive program, the Quality Payment Program (QPP). The QPP improves Medicare by helping eligible clinicians focus on care quality and making patients healthier. This program is the latest in a series of steps the Centers for Medicare and Medicaid Services (CMS) has taken to incentivize high quality of care over service volume.
The Quality Payment Program went into effect on January 1, 2017 and has two paths for participation
Effective January 1, 2017, Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) will be consolidated into the new Merit-based Incentive Payment System (MIPS). This is one of the two tracks under the Quality Payment Program. MIPS streamlines the financial impact of the various measurement and reporting tools, along with claims-based financial considerations that have become familiar since the adoption of digital health records.
Provider performance will be measured which will influence Medicare reimbursement payments each year. The four categories that will be used to measure performance are: Quality, Promoting Interoperability, Cost and a new category called Improvement Activities.
For the reporting years 2017 and 2018 (impacting reimbursements in 2019 and 2020), the following providers are MIPS-eligible clinicians: physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists. In 2019, the pool of eligible clinicians expands considerably.
All Medicare Part B providers who meet the definition of a MIPS ELIGIBLE CLINICIAN should plan to participate in MIPS in 2017 or they will be subject to a negative 4% payment adjustment on Medicare Part B reimbursements in 2019.
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