MACRA

CMS just released proposed rule on MACRA (MIPS and APMs)

The MACRA will move more quickly toward paying for value and better care. It also makes it easier for more health care providers to take part in quality programs in one of two streamlined ways:

1. Merit-Based Incentive Payment System (MIPS)
2. Alternative Payment Models (APMs)

MIPS and APMs will go into effect over a timeline from 2015 through 2021 and beyond.

What’s the Merit-Based Incentive Payment System (MIPS)?

The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

• Quality
• Resource use
• Clinical practice improvement
• Meaningful use of certified EHR technology

What are Alternative Payment Models (APMs)?

APMs give new ways to pay health care providers for the care they give Medicare beneficiaries. For example:

• From 2019-2024, pay some participating health care providers a lump-sum incentive payment.
• Increased transparency of physician-focused payment models.
• Starting in 2026, offers some participating health care providers higher annual payments.

Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.

What is the relationship to documentation ? 

Claims data and other data will determine how the quality incentives will be calculated