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In 2015, the US Senate passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), creating a pay-for-performance oriented Medicare reimbursement program. The newly formed Quality Payment Program will have a significant effect on reimbursement.
Effective January 1, 2017, Meaningful Use (MU), Physician Quality Reporting System (PQRS), and Value-Based Modifier (VBM) will be consolidated into the new Merit-based Incentive Payment System (MIPS). This new track will merge and strengthen the financial impact of the various measurement and reporting tools, along with claims-based financial considerations that have become familiar since the adoption of digital health records.
Provider performance will be measured which will influence Medicare reimbursement payments each year. The four categories that will be used to measure performance are: Quality, Promoting Interoperability, Cost and a new category called Improvement Activities.
For the reporting years 2017 and 2018 (impacting reimbursements in 2019 and 2020), the following providers are MIPS-eligible clinicians: physicians, physician assistants, nurse practitioners, clinical nurse specialists, and nurse anesthetists. In 2019, the pool of eligible clinicians expands considerably.
Referenceshttps://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html
https://www.federalregister.gov/documents/2016/11/04/2016-25240/medicare-program-merit-based-incentive-payment-system-mips-and-alternative-payment-model-apm
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/Final-MDP.pdf
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