The U.S. Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in Spring 2015.
The legislation had two primary goals:
- Replace the flawed physician payment update schedule called the Sustainable Growth Rate (SGR).
- Merge several disparate quality programs (i.e. Physician Quality Reporting System (PQRS), Value-Based Payment Modifier (VM) and the Electronic Health Record (EHR) Incentive Program into a single program now called the Quality Payment Program (QPP).
QPP is a physician payment reform program that seeks to move physician payment from volume to value by aligning Medicare payments to quantifiable performance and quality metrics.
Under the QPP, clinicians have two reporting tracks to choose from:
- The Merit-based Incentive Payment System (MIPS) or
- Advanced Alternative Payment Models (APMs)
Individual physicians, along with their practices and the hospitals, must consider many factors when determining the investment and resources needed to be successful, including:
- Payment: Being an optimal provider in both the MIPS and APM pathways is essential as there are financial penalties associated with not meeting the quality/cost requirements.
- Staffing/Financial Resources: Dedicating financial resources for additional staffing to improve patient care and quality reporting infrastructures are important considerations to properly comply with the law.
- Workflow Disruptions: The changes to quality reporting and incentives under physician payment has greatly impacted the ways in which providers interact with their patients and care teams.
ASA had a measured response to MACRA Legislation in 2015 – not endorsing or opposing the legislation – because of both MACRA’s uncertainties and its failure to directly address the “33 percent” problem.