Understanding Medicare's Quality Payment Program (MACRA)
- Medicare Access and CHIP Reauthorization Act of 2015 (MACRA)
- When do the new payment programs go into effect?
- Which path should I take?
- What is AUGS doing regarding the implementation of MACRA?
- Additional Resources for learning about MACRA and the Quality Payment Program
On April 16, 2015, President Barack Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). This legislation is meant to reform the way that Medicare reimburses physicians and other healthcare providers that bill the Medicare Physician Fee Schedule. As part of the proposed rule to implement MACRA, the Centers for Medicare and Medicaid Services (CMS) renamed the programmatic features as the “Quality Payment Program.”
How does the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) reform Medicare payment for healthcare providers – i.e. physicians, nurse practitioners, physician assistants, and clinical nurse specialists?
The MACRA Law makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. These new payment polices are now known as the “Quality Payment Program (QPP)”:
- Ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments.
- Creates a new framework for rewarding health care providers for giving better care not more care.
- Combines existing quality reporting programs – i.e. Physician Quality Reporting System (PQRS), Valued-based Payment Modifier (VBM) and the Meaningful Use of Electronic Health Records – into one new system.
This Quality Payment Program replaces a patchwork system of Medicare reporting programs with a flexible system that allows health care providers to choose from two paths that link quality to payments:
- Merit-Based Incentive Payment System (MIPS)
- Advanced Alternative Payment Models (APMs)
MIPS and APMs go into effect over a timeline from 2017 through 2021 and beyond.
The new Merit Incentive Payment System (MIPS) and the option of participating in an approved Advanced Alternative Payment Model (APM) will begin on January 1, 2017 for the first reporting period under the Quality Payment Program. Activities reported in 2017 will be used by CMS to adjust payments to eligible providers under the Quality Payment Program in 2019.
To learn more before you make your decision regarding which pathway is right for you, take a few minutes to watch this video produced by the U.S. Department of Health and Human Services (HHS).
AUGS continues to work with CMS and Congress to ensure that the agency implements new payment systems in a way that makes sense for how AUGS members deliver quality care and that minimizes administrative burdens. On April 27, 2016, a proposed rule was issued by CMS signifying the most extensive change in physician payment policies in the last two decades. The AUGS Quality and Coding Committees worked diligently to analyze the information to determine how it will impact urogynecology practices. AUGS submitted comments on this proposed rule. The final rule was released October 14, 2016.
With the introduction of MACRA, providers are paid based on treatment outcomes, quality of care, efficiency and patient satisfaction. The AUGS Urogynecology Quality Registry, AQUIRE, has been developed as a means for members to track these parameters. In 2017, AUGS will apply for QCDR status and users will be able to submit quality measures more easily to CMS and other private insurers for reimbursement should they choose to do so. AUGS will be sharing information with its members regarding the specific requirements for 2017 reporting.
MACRA’s Impact on Your Practice: How to Succeed within the New Framework
AUGS has developed an educational course to help members understand how to succeed within the new Quality Payment Program and to qualify for a bonus for the 2017 reporting year. Attend the course and learn more about the tools and resources AUGS has available to help you fulfill this new physician reimbursement model. Learn more about the course.
AUGS Quality Committee continues to focus on development of future measures.