Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) payment reform legislation officially went into effect in October, when the Centers for Medicare & Medicaid Services (CMS) final rules were published that tied future “payment adjustments” for Medicare providers to their performance on quality measures under a Merit-based Incentive Payment System (MIPS).
MIPS will be the dominant payment reform pathway for health care providers (HCPs) under Medicare’s new “Quality Payment Program” (QPP).
In Year 1 (2017), performance on quality will drive 60% of the score that determines these providers’ Medicare payment adjustments. Yet only 2 years after the start of the QPP, the formula shifts significantly away from quality and toward HCPs’ ability to manage cost.
In fact, in 2019, HCP performance on quality will drive 30% of the score—and cost, which is not even a factor in 2017, will have the same weight as quality (also 30%).
MIPS will factor in 2 other measures to incentivize continuous quality improvement (“Improvement Activities”) and meaningful use of Health Information Technology (“Advancing Care Information”).
These 4 ratings together will factor into a single physician score that determines each HCP’s annual payment adjustment.
Implication: With both quality and cost being critical components of MACRA legislation, brand value propositions must demonstrate proven, relevant outcomes and/or potential impact on cost (prescription and total cost of care).