MACRA and the Changing Medicare Payment Landscape.

Area of Science:

• Healthcare Policy
• Medical Economics

Background:

• The Medicare Access and CHIP Reauthorization Act (MACRA) established the Quality Payment Program (QPP).
• QPP modifies Medicare physician reimbursement, replacing the Sustainable Growth Rate with the Merit-based Incentive Payment System (MIPS).

Purpose of the Study:

• To summarize the regulations of the Quality Payment Program (QPP) for its initial performance period.
• To provide guidance for physicians, particularly surgeons, on navigating the new MIPS framework.

Main Methods:

• Review of MACRA legislation and Centers for Medicare and Medicaid Services (CMS) resources.
• Analysis of QPP regulations for the first performance year.

Main Results:

• Physicians can avoid penalties in 2017 by submitting minimal quality data, one improvement activity, or base score in advancing care information.
• A reduced reporting period allows data collection to begin as late as October 2nd for full scoring.

Conclusions:

• Surgeons must prepare for QPP success to ensure continued Medicare reimbursement.
• The transition period facilitates penalty avoidance and offers an opportunity to test participation and performance improvement strategies.