MACRA: Making Headlines Again in 2016
Streamlining the process to improve quality and affordability of healthcare
The Medicare Access and CHIP reauthorization Act (MACRA) was passed in 2015 but it continues to make headlines due to the sheer number of changes that are being implemented now and in the near future. MACRA was a comprehensive piece of legislation that was passed by congress in a monumental effort to halt the piecemeal changes and short term fixes and instead, issue over-arching changes to our Medicare system. Writing and passing MACRA was no small feat. It required groups from both parties, medical associates and even patient care groups to put forth and deliberate on a number of solutions.
One of the major changes that these groups achieved was to readjust the focus or change the criteria upon which doctors and clinicians are incentivized. Previous to this legislation, there were a number of different groups that awarded incentives to physicians and clinicians based on the number of Medicare patients that they treated. MACRA is working to now reward or reimburse healthcare providers based on the quality of care that they provide to these patients. The goal is, that through better quality of care, a fewer number of serious cases will require expensive procedures and interventions, and saving money for the both patients and the taxpayers. MACRA aims at making healthcare better and more affordable through these comprehensive changes.
In a statement released by HHS.gov, at least six different alternative payment models and organizations were named to provide an understanding of just how complex the previous system was. The greater the complexity of a system, the greater the room there is for error, which in this case was costly. With the 2015 legislation Congress created a framework to help doctors and clinicians with this transition, resulting in two pathways to seek reimbursement and incentives.
The Merit-Based Incentive Payment System (MIPS)
As the federal healthcare legislation is implemented and the focus of the incentive programs shifts from the quantity of Medicare patients seen to the quality of care provided to these patients, a new incentive payment system was created. The Merit-Based Incentive Payment System or MIPS was created to evaluate and award incentives to healthcare providers. Under MIPS, there are four grading criteria for incentives. These are: quality, advancing care information, clinical practice improvement activities and cost.
Healthcare providers may be evaluated against the four criteria for this payment system as early as 2017, but payments may not begin to be awarded until 2019.
Advanced Alternative Payment Models
For physicians and clinicians who take even greater strides towards providing a higher quality of care than are required for the MIPS incentives, an alternative payment model was created. Healthcare providers who strive to achieve these advancements can opt out of MIPS and seek this alternative payment models.
In these models, clinicians accept both risk and reward for providing coordinated high quality of care. Two examples of these new models are the Comprehensive Primary Care Plus (CPC+) Model and the Next Generation ACO Model.