What is Medicare new program MACRA talks about

MACRA :

The above abbreviation stands for Medicare Access and Chip Re-Authorization Act.

Medicare keeping in mind to reduce the rising cost in delivering healthcare and in the interest of keeping patient most healthier, introduced some quality payment programmes.  By asking the top providers in the country to join this drive, has made the providers life easier, patient healthier and the rising costs reduced.  As we all are aware Medicare was paying the providers through a method namely “FFS – Fee for service”.  This service actually depends on the sustainable growth rate formula created for fixing the prices for the services provided.  Each year, the congress used to pass a bill which affected the providers remuneration to greater extent as these were based on volume and not the quality of services provided.

Quality payment programme has provided 2 ways to track the quality measures to the providers:

  1. MIPS (Merit based Incentive payment systems)
  2. APMs- Advanced Alternative payment models.

MIPS – When providers participate in MIPS they will be entitled to earn a performance based incentive.  They have laid certain criteria for certain providers, as for MIPS is concerned.  The providers must also be 1. Physician, 2. Physician assistant, 3. Nurse practitioner, 4. Clinical Nurse specialist or 5. CRNA’s.  If they are ready to participate, they have to submit the data on the quality measures undertaken, electronically, for the period Jan 1 2017 – Dec 31 2017 by March 31, 2018.  If they do not participate, then they are entitled for a negative payment retraction of 4% by Jan  1, 2019.

Not only this, Medicare has provided 3 options to choose for those providers who wish to participate for MIPS.  They could 1. select to submit a few quality measures data, 2. Partial year submission 3. Full year submission.

APM’s – When providers participate in Advanced Alternative Payment Model system, they will be entitled to earn the incentive based on the quality measures provided on the APM”s.  The participating providers should submit the data on the quality measures undertaken, electronically, for the period Jan 1 2017 – Dec 31 2017 by March 31 2018.  Through this programme, the providers are entitled for a 5% incentive.  If not, they are entitled for a negative payment adjustments by 2019.

If the providers participate in these quality measures and are successful, they could reach higher heights in terms of remuneration, patient satisfaction and in return, more business expansions can happen.  If not, their negative retraction will be higher…

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