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With efforts of providing clinicians the tools and flexibility to provide high-quality, patient-centered care, the Department of Health & Human Services (DHHS) recently finalized and published a new payment system for Medicare clinicians, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).  This new system was designed with input from thousands of clinicians and patients across the country.  MACRA repeals the Medicare Part B Sustainable Growth Rate (SGR) reimbursement formula and replaces it with a new value-based reimbursement system. It also signifies the largest and most complex change to Medicare billing in many years.

Partnering with clinicians provided the Administration a clearer understanding of patients’ needs allowing them to build a system that will help deliver higher quality care; a system that will streamline Medicare payments, and put patients at the center of their healthcare. The changes overall are an honorable effort by CMS to reward clinicians for providing expert care to their patients.

“It’s time to modernize the Medicare physician payment system to be more streamlined and effective at supporting high-quality patient care. To be successful, we must put patients and clinicians at the center of the Quality Payment Program,” said Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). “A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose. Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures.”

Clinicians at local health departments, FQHCs or other healthcare agencies can choose one of two payment models:  the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS).  According the new Quality Payment Program website, “if you decide to participate in an Advanced APM, through Medicare Part B you may earn an incentive payment for participating in an innovative payment model.  If you decide to participate in traditional Medicare Part B, then you will participate in MIPS where you earn a performance-based payment adjustment.” Ultimately, having more options will give clinician flexibility in choosing the path best suited for their health center or department’s needs.

As stated in the DHHS press release released on October 14, 2016, “the first path gives clinicians the opportunity to be paid more for better care and investments that support patients. The second path helps clinicians go further by participating in organizations that get paid primarily for keeping people healthy.”

For more details on the two new payment models, and determine which track would best suit your needs, check out the new Quality Payment Program website.