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In short, it's the beginning of a transition to value-based care, otherwise known as pay-for-performance.
The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is the most significant piece of healthcare legislation since the Affordable Care Act in 2010. It establishes a Quality Payment Program (QPP) that consists of two payment tracks: Merit-Based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs). Performance measurements for the QPP begins on January 1, 2017.
The QPP applies to physicians, physicians assistants (PAs), nurse practitioners (NPs), clinical nurse specialists (CNS), certified registered nurse anesthetists (CRNSs), and groups that include such clinicians who bill for items and services covered under Medicare Part B Physician Fee Schedule. An Eligible Clinician (EC) is any provider who sees greater than or equal to 100 Medicare patients and bill more than $30,000 in Medicare Part B Allowables per person per year. In 2017, most ECs will fall into the MIPS track, although those participating in CMS’ innovative payment models may qualify for the APM track.
Providers qualified as MIPS ECs who do not participate will be penalized a percentage of the Medicare revenue. With a two-year lag between performance and payment adjustments, those who do not participate at all in any of the three “pick-your-pace” options in 2017 will be penalized 4% of their Medicare revenue in 2019. These penalties increase with further non-compliance. However, if you submit a minimum amount of data in 2017, you can avoid a penalty adjustment in 2019.
Providers that participate in non-advanced APMs or advanced models that do not achieve qualifying thresholds fall under the “MIPS APM” category. These providers must participate in MIPS, but are exempt from some of the reporting requirements while earning additional points in others.
MedInformatix ELIXIR is the gateway to effective, Merit-based Incentive Payment System (MIPS) and CPC+ Advanced Alternative Payment Model (APM) reporting. The MedInformatix ELIXIR interface links your MedInformatix EHR to any of more than 20 registries. When your practice connects to a registry through ELIXIR, it streamlines the reporting process and allows practitioners to go beyond quality measures.
MedInformatix clients can be assured that we will have you prepared for the aggressive changes to come.