A new set of changes promises to transform the Medicare reimbursement landscape, and HIM has a role to play. That was the message of Robert Anthony, deputy director, quality measurement and value-based incentives group at the Center for Clinical Standards and Quality, Centers for Medicare and Medicaid Services (CMS), during his presentation Monday at AHIMA’s Advocacy Leadership Symposium in Washington, DC.
In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was signed into law, which includes payment provisions that reward payment and value. Specifically, MACRA introduced the Merit-based Incentive Payment System (MIPS) program and will establish incentives for physicians participating in alternative payment models (APMs) such as accountable care organizations, patient-centered medical homes, and bundled payment models. Providers can go down one path or the other. “We think that it is critical to design programs that offer people multiple ways to get to success,” Anthony said.
MACRA built in the idea of linking value and quality—specifically linking payment to quality measurement, Anthony said. “We’ve learned a lot of lessons under [quality programs such as] PQRS and meaningful use. We have established certain goals to keep in mind,” he said.
The natural alignment of quality programs and meaningful use, Anthony said, is MIPS. That streamlining is intended to eventually minimize reporting burdens. If quality reporting becomes too burdensome, “reporting becomes the challenge to success,” Anthony said.
The law moves us toward “better care, smarter spending, and better outcomes, healthier people,” Anthony said. These goals are centered on three primary areas: incentives, care delivery, and information sharing.
MIPS changes consolidate three current quality and value programs for Medicare physicians and practitioners—the Physician Quality Reporting Program, the Value-based Payment Modifier, and the Medicare EHR Incentive Program, also known as “meaningful use.”
Starting in 2019, CMS must assess performance of practitioners and physicians in four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology. Each category will be weighted, Anthony said, and rolled up into a total composite score. The biggest emphasis initially will be on quality measures, followed by meaningful use. HHS will specify what “clinical practice improvement” activities are, Anthony said, and how it will be scored and measured.
Based on the MIPS composite performance score, eligible professionals (EPs) such as physicians and practitioners will receive positive, negative, or neutral adjustments to the base rate of Medicare Part B payments.
MACRA allows for a large upward adjustment for those who are high performers, Anthony said. “That is a real positive motivator for people,” he said.
CMS will issue timely feedback reports to each EP as soon as July 2017. It will also make information about EP performance available on the public Physician Compare website.
Anthony said that APMs are new approaches to paying for medical care. While the models are still being defined, some physicians and practitioners who participate in eligible APMs will receive lump-sum incentive payments from 2019 to 2024, and starting in 2026 some providers would receive higher annual payments. APMs will offer specific rewards. “MACRA is really designed to reward this path to value,” Anthony said.
More detail will be available in upcoming regulations, Anthony said, but it’s not clear when the regulations will be published. “This is going to be a significantly large rule… it’ll be done when it’s done,” he said.