On April 16, 2015, President Obama signed into law the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA makes three important changes to how Medicare pays those who give care to Medicare beneficiaries. 

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The law:

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• Repeals the Sustainable Growth Rate (SGR) formula for determining Medicare payments for health care providers’ services

• Makes a new framework for rewarding health care providers for moving away from fee-for-service and toward payment based on value

• Combines existing quality reporting programs (EHR Incentive Program, PQRS and VM) into one new system

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These proposed changes, which have been named the Quality Payment Program, replace a patchwork system of Medicare reporting programs with a flexible system that allows you to choose from two paths that link quality to payments: the Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

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Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS.

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Currently, Medicare measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs, including the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program. Through MACRA, Congress streamlined and improved these programs into one new Merit-based Incentive Payment System (MIPS).

 

Consistent with the goals of the law, MIPS improves the relevance and depth of Medicare’s value and quality-based payments and increases clinician flexibility by allowing clinicians to choose measures and activities appropriate to the type of care they provide. MIPS allows Medicare clinicians to be paid for providing high quality, efficient care through success in four performance categories: Cost, Quality, Clinical Practice Improvement Activities and Promoting Interoperability.