Public Payers News

Merit-Based Incentive Payment System Transforms Meaningful Use

MACRA requires three major Medicare programs to be combined under the Merit-Based Incentive Payment System.

By Vera Gruessner

- Last Spring, the Senate and the House of Representatives passed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) and repealed the former flawed SGR formula. Over the coming years, this law will require healthcare providers to participate in the Merit-Based Incentive Payment System or Alternative Payment Models.

Alternative Payment Model

The SGR formula failed the healthcare delivery system by making extensive cuts for Medicare providers and brought “doc fixes” that required too much time and money on the part of the federal government. However, MACRA puts an end to these problems and requires three major Medicare programs to be combined under the Merit-Based Incentive Payment System, the American Optometric Association reports.

The three programs being combined include the Electronic Health Record (EHR) Meaningful Use Program, the Physician Quality Reporting System (PQRS), and the Value Based Modifier (VBM) Program.

These programs are meant to either reward or punish providers based on the quality of their care and performance measure scores. When 2019 rolls around, the three programs will be fused together under the Merit-Based Incentive Payment System. Both Physician Quality Reporting and the EHR Incentive Programs revolve around ensuring that providers have effective electronic systems in place and meet healthcare quality measures.

The Value-Based Modifier Program involves compiling quality and efficiency information about a medical practice that will affect doctors’ Medicare reimbursement. Essentially, the value-based modifier is a code alteration that has to be included with medical claims.

The American College of Surgeons Division of Advocacy and Health Policy outlined in a brief how the meaningful use program, the Value-Based Modifier Program, and Physician Quality Reporting will all be integrated together under the Merit-Based Incentive Payment System. Meaningful use of electronic health records will move toward a different payment model by 2019 and penalties associated with failing to meet the requirements of the current program will end in three years.

Essentially, the Merit-Based Incentive Payment System will eliminate the penalties associated with the three current programs starting in 2019. While the penalties will be gone, a composite score will be used to provide doctors with financial incentive payments.

The American Academy of Family Physicians discussed remarks made last month by Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS). Slavitt had mentioned how the meaningful use program as it was once known will essentially be put to rest and a stronger management system will be instituted in its place.

The CMS Acting Administrator also mentioned how the federal agency has worked alongside physician organizations to develop a replacement for the meaningful use program and meet the needs of healthcare providers around the nation.

Slavitt explained that CMS will be releasing new information about updating and replacing the Medicare and Medicaid EHR Incentive Programs over the next few months. Most importantly, the focus of meaningful use will move away from the actual utilization of electronic medical records and bring more attention to patient health outcomes.

The Merit-Based Incentive Payment System may be the stimulus that is bringing meaningful use to be completely revamped at CMS. Changes to the meaningful use program are expected to be published in the more finalized MACRA regulations this coming spring.

While the overall name of the meaningful use program will change, it is very likely that many of its current requirements will continue to be mandated in the Merit-Based Incentive Payment System, the American Academy of Family Physicians reports.

Additionally, since there are essentially two payment systems under MACRA, providers who choose to follow the Alternative Payment Model may not be required to follow all of the stipulations of the EHR Incentive Programs since the Merit-Based Incentive Payment System will overtake meaningful use.

Those under the Alternative Payment Model will, however, need to pursue the operation of a patient-centered medical home or an accountable care organization, which may have similar stipulations to meaningful use of EHR technology.

“The implementation of the bipartisan MACRA legislation is a major item squarely on our punch list that has everyone’s attention. At its most basic level it is a program that brings pay for value into the mainstream through something called the Merit-based incentive program, which compels us to measure physicians on four categories: quality, cost, the use of technology, and practice improvement,” CMS Acting Administrator Andy Slavitt stated at the J.P. Morgan Annual Health Care Conference.

“The stakes are high for this program. As any physician will tell you, physician burden and frustration levels are real. Programs designed to improve often distract. Done poorly, measures are divorced from how physicians practice and add to the cynicism that people who build these programs just don’t get it. Over the next several months, we will be rolling out details, but for now a couple of themes,” Slavitt continued.

“At its core, we need to simplify. We have the opportunity to sunset three old programs and align them together in a single new program. That program needs to be streamlined and simple to use so physicians can focus where they need to – on their patients.”

“We are designing from the outside-in. We started by working with front-line physicians, tech companies, and practice managers over a four day session and through an RFI to garner direct feedback on the right measures for each specialty and how to implement the program most simply.”

“We are committed to building a program that is flexible and adapts around the goals of a provider’s individual practice and patient population,” he explained. “I would be remiss if I didn’t add that like any good start up, we will start small and leave a lot of tool building opportunities to the private sector.”

“Now that we effectively have technology into virtually every place care is provided, we are now in the process of ending meaningful use and moving to a new regime culminating with the MACRA implementation.”

“The meaningful use program as it has existed, will now be effectively over and replaced with something better.”