From Meaningful Use to MACRA
As the healthcare landscape continues to rapidly change, it is becoming increasingly more important to keep pace with the many and most significant catalysts behind that change. The Health Information Technology community has been anxiously awaiting Meaningful Use (MU) updates and clarification on Stages 2 and 3. When released in October 2015, there was a flurry of activity to review and comprehend the new information. The Meaningful Use information is important for hospitals and physicians as it defines the requirements for collecting incentive payments that were made available through the American Recovery and Reinvestment Act of 2009.
A much more ‘impactful’ healthcare law passed in 2015 (that will bring significant change)…is the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA), which defines future payment reforms and structures for Medicare & Medicaid. MACRA consolidates some familiar incentive programs; Merit-Based payment programs like PQRS (Physician Quality Reporting System), Alternative Payment Models (such as ACOs and Patient Centered Medical Homes) and Meaningful Use, into a single program. The law also includes a two-year extension of the Children’s Health Insurance Program (CHIP) as part of the legislation.
So what does all this mean for Jersey Health Connect and its members? It means that IT-centered healthcare initiatives are being hard-wired into the payment structures of our industries largest payers: Medicare & Medicaid. We are already seeing commercial insurers following the trend with risk-based payment models. Since many of the most significant MACRA payment changes are scheduled for 2018, JHC will work through 2016 to ensure that appropriate infrastructure is in place in the HIE to collect, store, and analyze health data to support quality reporting, optimize efficient delivery of services and utilize healthcare analytics to support the new paradigms.
MACRA Background and Facts
In April 2015, the President signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (HR 2, also known as MACRA). This law:
- Repeals the Sustainable Growth Rate methodology for determining updates to the Medicare physician fee schedule.
- Establishes annual positive or flat fee updates for 10 years and institutes a two-tracked fee update afterwards.
- Establishes a Merit-Based Incentive Payment System that consolidates existing Medicare fee-for-service physician incentive programs.
- Establishes a pathway for physicians to participate in alternative payment models, including the patient-centered medical home.
- Makes other changes to existing Medicare physician payment statutes.
Under MACRA, existing reporting programs are combined into one single scoring system called MIPS. These existing reporting programs are:
- Physician Quality Reporting System (PQRS)
- Value Modifier (VM or Value-based Payment Modifier), and
- Medicare Electronic Health Record (EHR) incentive program (“Meaningful Use”)
What is Merit-Based Incentive Payment System (MIPS)?
The Merit-Based Incentive Payment System (MIPS) is a new program based on Quality, Resource Use, Clinical Practice Improvement and Meaningful Use of Certified EHR Technology. Starting in 2017, the Merit-Based Incentive Payment System will annually measure Medicare Part B providers in four performance categories to derive a “MIPS Score” (0 to 100), which can significantly change a provider’s Medicare reimbursement in each payment year. The performance categories are:
- Meaningful Use (25 points)
- VBM quality based upon PQRS measures (up to 30 points)
- VBM cost or resource use performance (30 points)
- Clinical Practice Improvement – a new category (15 points)
(NOTE: to learn more about the Merit-Based Incentive Payment System – visit the SA Ignite website for a detailed MIPS Frequently Asked Questions overview at http://www.saignite.com/resources/faq-about-merit-based-incentive-payment-mips)
NOTE: The following information is provide from The Advisory Board Company. To view the entire article – please go to https://www.advisory.com/research/health-care-advisory-board/blogs/at-the-helm/2015/04/sgr-repeal