Making Sense of the Quality Payment Program

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In April 2015, the U.S. Congress passed and President Barack Obama signed bipartisan legislation known as the Medicare Access and CHIP (Children's Health Insurance Program) Reauthorization Act (MACRA). Designed to reform health care payment and administration, MACRA repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new pay-for-performance program — the Merit-Based Incentive Payment System (MIPS).

MIPS combines parts of the Physician Quality Reporting System (PQRS), the Value-based Payment Modifier and the Medicare Electronic Health Record (EHR) incentive program into one single system in which eligible providers will be measured on quality, resource use, clinical practice improvement and meaningful use of certified EHR technology.

MIPS and Alternative Payment Models (APMs) — another path under the Quality Payment Program which includes Accountable Care Organizations (ACOs), patient-centered medical homes and bundled payment models—will go into effect over a timeline through 2021 and beyond.

[MACRA] is the opportunity to change how Medicare pays for care, but also the opportunity to achieve something bigger: to support the kind of care that patients want — with physicians able to anticipate and focus on their needs,” said Andy Slavitt, Centers for Medicare & Medicaid Services (CMS) Acting Administrator in remarks made to the American Osteopathic Association in July 2016.

[MACRA] is the opportunity to achieve something bigger: to support the kind of care that patients want."

With the goal to achieve long-term stability and reliability for the Medicare program, CMS and Quality Innovation Network-Quality Improvement Organizations (QIN-QIOs) have developed a variety of resources to keep providers and other stakeholders educated and informed during this transition period.

To cite some examples, Health Services Advisory Group (HSAG), the QIN-QIO for Arizona, California, Florida, Ohio and the U.S. Virgin Islands, developed this educational Quickinar Series. Qualis Health, the QIN-QIO for Idaho and Washington, has released a MIPS Minute Series” to walk providers and other stakeholders through the basics of the changes. And the CMS website houses a number of valuable resources here and here.

The final rules for MACRA will be published November 1, 2016. Check back in future issues of QIO News for clarification on these and any other updates.