By: Susan D’Agostino, RN
MACRA, MIPS, APMs…the list goes on.
Just when you think you have them all down, CMS (Centers for Medicare & Medicaid Services) comes up with more.
Let’s go through a brief breakdown of what all these acronyms mean.
MACRA– Medicare Access and CHIP Reauthorization Act of 2015
MACRA repeals the Medicare Sustainable Growth Rate (SGR) formula that calculated payment cuts for physicians. It creates a new framework for rewarding physicians for providing higher quality care by establishing two tracts for payment:
- MIPS (Merit Based Incentive Payment System) – will make payment adjustments based on performance on quality, cost and other measures, and will consolidate components of three existing programs—the Physician Quality Reporting System (PQRS), the Physician Value-based Payment Modifier (VM), and Meaningful Use (MU).
- APMs (Alternative Payment Models) – are a payment model expanded under the Center for Medicare and Medicaid Innovation (CCMI) with the exception of Health Care Innovation award recipients, a Medicare Shared Savings Program (MSSP) Accountable Care Organization (ACO), or a Medicare Health Care Quality Demonstration Program or Medicare Acute Care Episode Demonstration program. APMs can apply to a specific clinical condition, a care episode, or a population. An Advanced APM allows a practice to earn more for taking on some risk related to their patients’ outcomes.
For more information on the Quality Payment Program visit: https://qpp.cms.gov/measures/performance
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