In June and August, Producer Pulse included stories about the Medicare Access & CHIP Reauthorization Act (MACRA). MACRA will move Medicare payments further away from a fee-for-service model and toward a value-based purchasing strategy.
Since then, the Centers for Medicare & Medicaid Services (CMS) has released the MACRA Final Rule (with Comment Period), which will implement the paradigm-shifting Quality Payment Program (QPP). The program ushers in significant changes to Medicare payments, care delivery, and the health care industry as a whole—including two changes that are of particular interest to Group Health and our mutual clients:
- Beginning on Jan. 1, 2017, CMS will reimburse Medicare-enrolled providers by rewarding
value, rather than volume of care. Providers and provider groups can choose between the Merit-Based Incentive Payment System (MIPS), which will make payment adjustments to certain Medicare-participating clinicians based on quality, cost, and other measures; and the Advanced Payment Model (APM), which will offer additional rewards to providers who are prepared to accept downside financial risk. Both tracks reward providers for investments in technology and quality improvements.
- Medicare-enrolled providers will receive incentives to seek downside risk-bearing contracts with Medicare Advantage and Medicaid managed care organizations, and with commercial health plans. Beginning in 2019, providers who opt for the APM track may secure their reimbursement under that model by combining their participation in entities called Medicare Advanced APMs and Other Payer Advanced APMs.
Group Health has assembled a team of delivery system and health plan stakeholders to consider the final MACRA rule and prepare a comments letter to CMS, due by Dec. 19. The team is also developing recommendations on how to implement the new value-based payment system, and we’ll keep you posted as we learn more about that process.
View the CMS Executive Summary on the MACRA final rule if you’d like more details.