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Current Healthcare Trends / MACRA

What is MACRA?

MACRA, or Medicare and CHIP Reauthorization Act of 2015, changes the reimbursement model used to reimburse for Medicare and Medicaid services from a fee for service model to a Quality Payment Program (QPP) reimbursement model. MACRA:

  1. Ends the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care provider services.

  2. Creates a new framework for rewarding health care providers for giving better, not more care.

  3. Combines the existing quality reporting programs into one new system.

What's the MACRA Quality Payment Program?

The MACRA QPP moves the United States health care payment system model towards payment for value to patients, not for service volume.  The Quality Payment Program has 2 paths:

  1. Merit-Based Incentive Payment System (MIPS)

  2. Alternative Payment Models (APMs)

The MIPS is a new program that combines parts of the Physician Quality Reporting System (PQRS), the Value Modifier (VM or Value-based Payment Modifier), and the Medicare Electronic Health Record (EHR) incentive program into one single program in which Eligible Professionals (EPs) will be measured on:

  1. Quality

  2. Resource use

  3. Clinical practice improvement

  4. Meaningful use of certified EHR technology

What are Alternative Payment Models (APMs)?

APMs give us new ways to pay health care providers for the care they give Medicare beneficiaries. For example, from 2019-2024, some participating health care providers will receive a lump-sum incentive payment. Accountable Care Organizations (ACOs), Patient Centered Medical Homes, and bundled payment models are some examples of APMs.

What should allied health professionals do about MACRA?

You should begin now to use quality and performance tools, comply with outcomes documentation, and implement patient satisfaction assessments. Public and private payers are already expanding contractual arrangements to include these requirements. The estimated time for expanding MACRA to allied health professionals is in approximately 2019.

Click here to order copies of patient satisfaction surveys and begin improving your performance practices today.