Institute:Office of National Coordinator (ONC) Workforce Training Curriculum
Component:The Culture of Health Care
Unit:Quality Measurement and Improvement
Lecture:Current quality measures in use
Slide content:Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) Two components: The Merit-Based Incentive Payment System (MIPS) Combines programs into a single system The Alternative Payment Models (APMs): New models for provider reimbursement such as accountable care organizations and patient-centered medical homes Applies to Medicaid patients 2020 targeted timeframe 19
Slide notes:The Medicare Access & CHIP Reauthorization Act of 2015 (MACRA) is a payment reform regulation that changes how Medicare reimburses providers for the care they provide to Medicare patients. It includes a new framework for rewarding health care providers for giving better care (not just more care) and for combining existing quality reporting programs into one new system. MACRA supports the goal of paying for value and better care, which is the same goal of many other programs, including meaningful use and quality measure programs. The goal of MACRA is to make it easier for providers to participate in federal quality programs through participation in either the Merit-Based Incentive Payment System (MIPS [mips]) or the Alternative Payment Models (APMs [A-P-ems]). The MIPS program combines parts of the PQRS, the value modifier (or value-based payment modifier), and the Medicare EHR incentive program (meaningful use) into a single program based on quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology. The APM program provides new ways to reimburse providers for the care provided to Medicare patients. Examples include Payment of a lump-sum incentive payment from 2019 to 2024 to some providers. Increased transparency of physician-focused payment models. Offer of higher annual payments to some providers beginning in 2026. Examples of organizations or care delivery models that are considered participants in the APM program include accountable care organizations, patient-centered medical homes, and bundled payment models. MIPS and APMs implementation is through a phased process based on specific timelines that began in 2015 and will continue through 2021 and beyond. The traditional fee-for-service reimbursement model is targeted to be phased out by 2020 for Medicare patients, leaving MIPS and certified APM participants as the new Medicare reimbursement models. 19