Question

Briefly discuss the Medicare Access and CHIP Reauthorization Act (MACRA). How does it impact patient care? How does it impact healthcare providers?

Answer 1

QUESTION:

Briefly discuss the Medicare Access and CHIP Reauthorization Act (MACRA). How does it impact patient care? How does it impact healthcare providers?

ANSWER

Introduction:

In response to rising Medicare costs, Congress passed the Medicare Access and Children’s Health Insurance Program Reauthorization Act in 2015. The law fundamentally changes the way that health care providers are reimbursed by implementing a pay for performance system that rewards providers for high-value health care.

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA):

• It changes the payment system for doctors who treat Medicare patients.

• It is passed in 2015 with bipartisan support, MACRA (Medicare Access and CHIP Reauthorization Act of 2015) is U.S. healthcare legislation

• It provides a new framework for reimbursing clinicians who successfully demonstrate value over volume in patient care.

• The CHIP in the full MACRA name stands for the Children's Health Insurance Program, for which MACRA extends funding.

• The legislation went into effect April 16, 2015, with subsequent deadlines for various aspects of the law from the Department of Health and Human Services (HHS) and the Centers for Medicare and Medicaid Services (CMS).

Facts:

The Mantra: Better Care with Lower Cost and improved Experience

Medicare Access and CHIP Reauthorization Act of 2015 (MACRA):

• MACRA removed the Sustainable Growth Rate (SGR) formula
• Minimum Annual Physician Fee Schedule (PFS) rate updates
• Established two Quality Incentive Programs:

Merit Based Incentive Payment System: MIPS

Advanced Alternative Payment Models: APMs

MIPS and APMs Both Intend to

• Improve quality and improve patient health
• Advance electronic medical records
• Control spending
• Provide Reimbursement Incentives for changing Clinical Practices

MACRA's primary provisions :

· Changes to the way Medicare doctors are reimbursed

· Increased funding

· Extension to the Children's Health Insurance Program (CHIP).

Impact of MACRA/MIPS:

1. Change the way care is given and paid for by CMS
2. Change health delivery model to one based on Primary Care and Community-based care…and
3. Transform Primary Care to achieve desired results of Population Health and Alternative Payment Models
4. Move to risk-based Alternative Payment Models using Population Health methodology

Changing how physicians and other providers are paid while driving practice transformation: two ways to participate:

MIPS (Merit Based Incentive Payment System) – most practices

• Quality

• Resource Utilization

• Clinical Practice Improvement

• Advancing Care Information (MU)

Advanced Alternative Payment Models (APM) – contracting for risk

• Next generation ACO (risk)

• Medicare Advantage

• Comprehensive Primary Care Plus

• Patient Centered Medical Home

MIPS – Four Determinants of Performance Score

1. Quality Reporting (60%)
   • Chose six metrics to report by end of 2016 for performance year 2017
   • Similar to PQRS – use same metrics and reporting system
2. Advancing Care Information (25%) – Replaces Meaningful Use
   • Dropping CPOE and decision support requirements after 2017
   • Very similar to current Meaningful Use requirements
3. Clinical Practice Improvement Activities (15%)
   • Flexible – can choose from 90 options – this is new
     • Examples include – care coordination; 24/7 access
4. Resource Utilization (0% - increases in coming years with decrease weight on quality).

MIPS advancing care information objectives and measures:

Six Criteria:

1. Protect Patient Health Information – Security Risk Analysis

2. Electronic Prescribing

3. Patient Electronic Access – Patient Access, Patient-specific education

4. Coordination of Care Through Patient Engagement – View/Download/Transmit, Secure Messaging, Patient Generated Health Data

5. Health Information Exchange – Patient Record Exchange, Request/Accept Patient Care Record, Clinical Information Reconciliation

6. Public Health and Clinical Data Registry Reporting – Immunization Registry Reporting

Clinician must:

1. Use 2014 or 2015 Edition Certified EHR

2. Report on either eight stage 2 or six stage 3 advancing care information objectives and measures

3. Attest to their cooperation in good faith with the surveillance and ONC direct review of the EHR

4. Attest to their support for health information exchange and the prevention of information blocking

Advancing Care Information Objectives:

1. Protect Patient Health Information

2. Electronic Prescribing

3. Patient Electronic Access

4. Health Information Exchange

MIPS Proposed Rule: Measurement Categories:

Quality measures fall under five quality domains:

• Clinical care
• Safety
• Care coordination
• Patient and care giver experience
• Population health and management

Changes in Medicare:

In its essence, MACRA was designed to eliminate a fee-for-service system, replacing it with a system that rewards high-value patient care and efficiency. MACRA made three important changes to how Medicare pays providers.

· The law repealed 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.

Medicare Access and CHIP Reauthorization Act (MACRA) impact patient care and healthcare providers:

MACRA’s impact will fundamentally alter the way services and care are evaluated and reimbursed. And while groups representing providers, plans and payers are actively discussing MACRA’s potential effects on their particular constituents, NRHI is assessing the law from every perspective. With stakeholder-members from the entire spectrum of the healthcare community, we’re looking at MACRA with an eye toward helping all of our stakeholders to prepare for the coming changes – and to leverage their potential to positively impact healthcare for providers, payers, purchasers and consumers alike.

• A growing percentage of physician payment will be based on value – not on volume – like the current fee-for-service system.

• High value care will be defined by measures of quality and efficiency and providers will earn more or less depending on their performance against those measures.

• Defining common measures may enable better care at lower cost.

• The rules will require compliance for compensation from the country’s largest payer, and because results will be available for public review, there’s reason to expect that MACRA will drive change for all patients and encourage broad-based transparency and accountability.

• Providers will be paid based on patient outcomes, they will need to know what happens across the system outside of their offices

• To effectively manage patient care, providers will be reliant on good, accurate data – often from multiple delivery systems.

• MACRA may provide the incentives for data sharing and greater standardization and usability of EHR technology.

• Data sharing standards are a key component of MACRA that will enable significant changes in patient care.

• As of the beginning, providers will be evaluated on quality and in later years, cost as well. High-quality, cost-efficient providers will receive bonuses in reimbursement, and low-quality, expensive providers will be penalized financially.

• The Centres for Medicare and Medicaid Services will evaluate provider costs through episodes of care, which are currently in development and alternative payment models.

• Nephrology providers have an opportunity to develop cost-efficient ways to care for patients during these transitions.

• An Alternative Payment Model (APM) is a payment approach that gives added incentive payments to provide high-quality and cost-efficient care. APMs can apply to a specific clinical condition, a care episode, or a population.

• Advanced APMs are a subset of APMs, and let practices earn more for taking on some risk related to their patients' outcomes. They may earn a 5% incentive payment by going further in improving patient care and taking on risk through an Advanced APM.

• Small practices with 15 or fewer clinicians, including those in rural locations, health professional shortage areas, and medically underserved areas are a crucial part of the health care system.

• The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) provides direct technical assistance to help individual Merit-based Incentive Payment System (MIPS) eligible clinicians and small practices in these settings participate in the Quality Payment Program.

• This initiative is comprised of local, experienced organizations that will help clinicians in small and rural practices:

• Select and report on appropriate measures and activities to satisfy the requirements of each performance category* under MIPS
• Engage in continuous quality improvement
• Optimize their health information technology (HIT)
• Evaluate their options for joining an Advanced Alternative Payment Model (APM)

• Providing this support to clinicians will help them navigate the Quality Payment Program, while making sure they are able to focus on the needs of their patients. Quality, Cost, Improvement Activities, and Advancing Care Information

• Funding for direct technical assistance to local, experienced organizations

• Help for small and rural practices to engage in continuous quality improvement

• Assistance to evaluate options for joining an Advanced Alternative Payment Model

• Support to navigate the Quality Payment Program.

Conclusion:

MACRA does many things, but most importantly it establishes new ways to pay physicians for caring for Medicare beneficiaries. The law also includes new funding for technical assistance to providers, funding for measure development and testing, it enables new programs and requirements for data sharing, and establishes new federal advisory groups. It is comprehensive legislation that has the potential to significantly restructure US healthcare.