At the moment, our healthcare system is far from perfect, and it can be difficult to keep track of all the changes in healthcare legislation. When it comes to healthcare organizations though, we carefully follow relevant health care reform such as the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA has just moved on to the next step in the legislative process. It’s now awaiting a final ruling at the Office of Management and Budget (OMB). So, why does MACRA matter to accountable care organizations like Catholic Benefits Trust?
Why MACRA Matters
MACRA was created to replace Medicare’s Sustainable Growth Rate after the Senate repealed it last year. The new legislation is more conducive to value-based care models and accountable care organizations (ACOs). Health care providers focused on value-based care and payment models will find two relevant programs under the new act:
1. Merit-Based Incentive Payment System (MIPS)
MIPS consolidates the Physician Quality Reporting System (PQRS), the Value Modifier, and the EHR Incentive programs. Starting in 2017, health care providers will receive an evaluation and a MIPS score based on four categories: quality of care, use of resources, improvement of clinical practice, and use of EHR technology. EHR technology enables the gathering and sharing of patient data so professionals can collaborate. MIPS focuses on these four categories because it encourages physicians to work with each other to develop inexpensive, preventative treatments that allow patients to avoid costly procedures and hospital stays.
2. Alternate Payment Methods (APMs)
Some models, such as ACOs, patient-centered medical homes, and bundled payment models qualify as alternate payment methods (APMs). This payment method offers health care providers 0.5% lump-sum incentive payments for their Medicare payments from 2019 to 2024. Providers will still receive evaluations similar to the four categories described under MIPS.
MACRA supports value-based healthcare models and preventative treatments. Incentives will encourage care providers to improve their services in all four areas listed under MIPS and provide quality, value-based care for their patients.