The Medicare Access and CHIP Reauthorization Act (MACRA), which is slated for final rule this fall, replaces former Sustainable Growth Rate (SGR) reimbursement provisions in favor of a new payment model centered on pay-for-performance and designed to promote better quality of care. Under the new framework physicians have two new reimbursement program paths.
The Merit-based Incentive Payment System (MIPS) combines three existing healthcare incentive programs – the Physician Quality Reporting System (PQRS), the Meaningful Use/EHR incentive program and the Value-based Payment Modifier (VBM) – into a new composite performance score. Based on how eligible professionals (EPs) fare, they will receive either a bonus, a penalty or no adjustment on Medicare payments.
Alternative Payment Models (AMP) will offer qualifying providers annual payment bonuses when physicians earn significant revenue or see sufficient patient percentages through qualifying Medicare or payer models, requiring the acceptance of some financial risk if spending surpasses targets. Accountable Care Organizations (ACOs), Patient Centered Medical Homes and bundled payment models are some APM examples.
- Sherri Bryant, Vidant Health
- Coleman Smith, Himformatics
- Mary McCaskill, NC AHEC Program
- Lori Harrington, Premier