Medicare and Medicaid are pushing for three goals in healthcare: improved care, wiser spending, and healthier people. The latest program to transition away from fee-for-service toward value-based payment systems is MACRA, which plans to focus on three areas: physician incentives, care delivery, and information sharing. For those groaning at a new program in the wake of the Meaningful Use requirements brought forth in 2009, CMS believes the new program will be an improvement with more flexible paths to success and ability to customize reportable measures to better fit specific practices.
1. What is MACRA?
MACRA stands for the Medicare Access and CHIP Reauthorization Act of 2015, a bipartisan legislation passed into law in April 2015. According the CMS the goal of this legislation is to "reward better care, not just more care." The primary goal is to move away from fee-for-service reimbursement toward a value-based payment system, with a goal of 85 percent of all Medicare payments being tied to quality or value. It also repeals the flawed Sustainable Growth Rate (SGR) which has plagued physicians since its inception in 1997, and since 2010 has threatened to cut fees to physicians for the services they provided by up to 25 percent, although Congress has persistently delayed its implementation. This repeal was seen as a great victory for physicians, but the remaining aspects of the legislation are still confusing. CMS purports this new plan will be more flexible and easier for physicians. Within the new Quality Payment Program there are two paths for physicians to participate: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs).