The Medicare Access & Children’s Health Insurance Program (CHIP) Reauthorization Act (MACRA) is about healthcare performance. As medicine advances toward emphasis on quality, physician payments are becoming more tied to quality of care, and MACRA improves how Medicare payments relate to quality or value. By 2018, 90% of payments will be linked to quality. For the consumer, this means better quality healthcare practices and safer medicine. For physician providers, it grants payment incentives for participation in the quality care models, and bonus payments for those participating in advanced alternative payment models (APMs). The new quality payment requirements accomplish three program goals – better care, smarter spending, and healthier people. Physicians must prepare for quality changes, including spending more time with patients, as part of participation.
There are multiple individual quality and value programs for Medicare physicians. Deciding how and what to participate in can be confusing. MACRA is intended to streamline the Physician Quality Reporting System (PQRS) and the Value-Based Payment Modifier under the Merit-based Incentive Payment System (MIPS). Essentially, there are three factors used to provide a MIPS composite performance score – quality resource use, clinical practice improvement activities, and meaningful use of EHR technology. Understanding MIPS composite performance will help independently practicing physicians (and physician groups) improve payments.
Alternative Payment Models (APMs) are exciting, as this new approach for paying for medical care through Medicare is a win for both the patient and the provider. According to the MACRA law, APMs include the Medicare Shared Savings Program, which is the federally-required Health Care Quality Demonstration.
ARDX is poised to bring this additional value to your practice and reduce overwhelming confusion and burden. Our experts consult with providers and advise on how to incorporate applicable MACRA components for your practice. We help physicians enhance their practices to ensure financial success for these quality steps.
Across the overarching MACRA incentive measurement categories our experts provide process and technical solutions for providers to –
- Avoid quality payment penalties and payment reductions
- Ensure performance reporting periods are met
- Establish most relevant measurement reporting
- Establish threshold monitoring and management (including coordination across categories)
- Implement risk management
About the Authors:
Marsha Mason-Wonsley, MA, BSN, HIT, CPC, is a Medicare payment policy and oversight expert. Her experience includes onsite hospital claims audits, State audits, pre and post payment review of physician claims, and freestanding facility claims. She currently sits on the AMA CPT Assistant Editorial Panel and is also a member of AHIMA. Ms. Mason-Wonsley has worked for government, private insurance, and managed care organizations.
Lateefah Hughes, DrPH, is Senior Health Policy Implementation Advisor and Chair of the ARDX Healthcare Expert Advisory Board. Dr. Hughes is also the Former Acting Deputy Director of Payment Policy and Financial Management and Director of the Division of Risk Adjustment Operations at the Centers for Medicare & Medicaid Services, Center for Consumer Information and Insurance Oversight (CCIIO). She has been instrumental in the development of policy and operations payment policies for Medicare Part C, Medicare Part D, and Medicare Risk Adjustment Data Validation.