The final reporting requirements for the new MACRA (Medicare Access and CHIP Reauthorization Act) rule for physician payment were finalized this month and will be implemented January 1, 2017. MACRA puts an increased focus on quality and value of care. According to CMS, the goal is to create and implement a core set of performance measures to be used by private and public insurers so all are on the same page when comparing quality, making data more easily gathered and understood. The intent is to build a system of better care where clinicians work together to have a full understanding of patients’ needs and making a health care system more responsive to patients and families resulting in better care, smarter spending and healthier people and communities. Therefore, Medicare pays for what works and spends taxpayer monies more wisely, and patients are in the center of their care, resulting in a healthier country.
A physician’s reimbursement may be increased or decreased depending on how well one performs on established quality and cost metrics. This new Medicare payment system for physicians allows for eligible physicians to participate in one of two tracts. The first tract is the Merit-based Incentive Payment System (MIPs). This gives clinicians the opportunity to be paid more for better care and investments that support patients. In the first year, it also provides a flexible performance period, so that those ready to report their data beginning in January can do so, but those who need more time to prepare reports may do so later in the year. The second path is called the Alternative Payment Model (APMs), such as participation in an accountable care organization or patient-centered medical home. APMs can apply to a specific clinical condition, a care episode, or a population. Clinicians get paid primarily for keeping people healthy. When they get better health results and reduce costs for the care of their patients, the clinicians receive a portion of the savings. Those excluded from the program are clinicians with low volume (less than 100 Medicare patients or less than $30K in Part B charges). At this moment, CMS will only provide performance feedback on an annual basis, but are exploring more timely feedback measures. It is anticipated that 2018 will also be a year of transition and that MACRA will continue to evolve.