What is MACRA/MIPS?
MACRA stands for Medicare Access and CHIP Reauthorization Act of 2015. CHIP stands for Children’s Health Insurance Program, and MACRA extends funding to CHIP. MACRA is a healthcare legislation that provides a new framework for reimbursing clinicians who successfully demonstrate value over volume in patient care.
The MACRA legislation went into effect in April 16, 2015. There are deadlines for implementation of various aspects of the law from the Department of Health and Human Services (HHS), and the Centers for Medicare and Medicaid Services (CMS).
There are three important changes made by MACRA which impact the way Medicare pays providers.
- The law repeals the Sustainable Growth Rate formula that determined Medicare payments for providers’ services.
- Participating providers are now paid based on the quality and effectiveness of care given.
- MACRA combined existing quality reporting programs into one new system.
Quality Payment Program
These changes included the creation of the Quality Payment Program (QPP), which helps the healthcare system move toward the goal of value-based care.
You can learn more about the QPP at the CMS websites here (qpp.cms.gov) and here (CMS.gov).
The QPP has two paths.
- Merit-based Incentive Payment System (MIPS): A program that measures eligible professionals on quality, resource use, clinical practice improvement and meaningful use of certified EHR technology.
- Alternative Payment Models (APMs): APMs create new ways for healthcare providers to get paid for the care they provide to Medicare beneficiaries. Some examples of APMs include accountable care organizations, patient-centered medical homes and bundled payment models.
Merit-Based Incentive Payments (MIPS)
MIPS is the combination of parts of the Physicians Quality Reporting System (PQRS), the Value-based Payment Modifier (VBM), and the Medicare Electronic Health Record Incentive Program into one single program under MACRA.
MIPS determines Medicare payment adjustments using a composite performance score. Depending on this composite score, eligible professionals may receive a payment bonus, a payment penalty or may not receive a payment adjustment at all.
The composite, or MIPS score measures eligible professionals based on four performance categories. These categories are all weighted differently.
- 50% for quality (PQRS and VBM)
- 25% for meaningful use
- 15% for clinical practice improvement
- 10% for resource use
The EHR Requirement
MACRA modifies, and perhaps will eventually replace the meaningful use stage 3 incentive program, as the law steers organizations toward using electronic health record (EHR) data for value-based care.
Under MACRA, if an EHR vendor would like their product to be considered a certified EHR, they must be able to do the following:
- Indicate the data source measures, activities and objectives under the Quality, Improvement Activities, and Advancing Care Information performance categories if the data is derived from a certified EHR technology.
- Transmit data from the certified EHR technology or through a data intermediary in the form specified by CMS.
- Allow individual MIPS-eligible clinicians and groups to submit data directly from their certified EHR technology in the form specified by CMS.
For more information about MACRA and MIPS, be sure to visit the CMS website, or the QPP website.