MACRA, QPP, MIPS, APMs – HUH?
by Donna Koger, 8.31.16
In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed. The goal is to ultimately change Medicare payments from quantity to quality based. It is also simplifying the reporting process merging Meaningful Use and PQRS together. So what does this mean for providers?
MACRA overhauls Medicare’s payments to clinicians by creating strong incentives for them to participate in Alternative Payment Models (APMs) that require financial risk-sharing and designed to improve quality.
Clinicians who are not participating in the APMs models must have their performance measured in four categories:
2. Resource Use
3. Health Information Technology (HIT) use
4. Clinical Practice Improvement
Eventually, measuring the costs associated with a clinician’s practice and referral patterns will grow to 30% of the performance formula. Together, these policies will encourage a much stronger focus on quality and total cost of care, as opposed to quantity of health care.
The Quality Payment Program (QPP) has two paths:
1. Merit-Based Incentive Payment System (MIPS)
2. Alternative Payment Models (APMs)
MIPS combines parts of PQRS, the Value Modifier (VM, also called the Physician Value-Based Modifier or PVBM) and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on:
- Resource Use
- Clinical Practice Improvement
- Meaningful Use of certified EHR technology
APMs give us 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
• Increase transparency of physician-focused payment models
• Starting in 2026, offer some participating health care providers higher annual payments
Patient Centered Medical Homes are examples of APMs. MIPS and APMs will go into effect over a timeline from 2015 through 2021 and beyond.
The CMS Quality Measure Development Plan (MDP), required by MACRA, is a focused framework to help build quality measures for clinicians in the future. These quality measures will support MIPS and APMs. To sum it up, the primary focus on the changes above seems to be centered on the Quality and not Quantity of care. Not a bad thing, right?
Since publication of this article, CMS has finalized key details of the program.
Donna Koger is currently the HIPAA Compliance Officer and materials developer for software training and support at Smoky Mountain Information Systems, home of PIMSY EHR. Ms. Koger is also a regular contributor to the PIMSY EHR blog.