Health Care Delivery and Payment Reform

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is poised to drive health care delivery and payment reform across clinicians, health systems, Medicare, and other government and commercial payers.

On May 9, 2016, the US Centers for Medicare and Medicaid Services (CMS) published a proposed rule that would implement key features of this law: the Merit-based Incentive Payment System (MIPS), which would apply to all eligible clinicians that Medicare pays under the Physician Fee Schedule (PFS), as well as the incentives for these clinicians to participate in Advanced Alternative Payment Models (APMs).

MACRA overhauls Medicare’s payments to clinicians by creating strong incentives for them to participate in APMs that require financial risk-sharing for a broad set of health services and that are designed to improve quality. Clinicians who are not counted as participating in these models will need to report and have their performance measured in four categories–quality, resource use, health information technology (HIT) use, and clinical practice improvement. Over time, resource use performance–measuring the costs associated with clinicians’ practice and referral patterns–will grow to 30 percent of the performance formula. Together, these policies will encourage a much stronger focus on quality and total cost of care.