Current and Future Status of Merit-Based Incentive Payment Systems.

Area of Science:

• Health Policy
• Healthcare Economics
• Medical Legislation

Background:

• The Sustainable Growth Rate (SGR) formula's failures necessitated legislative reform.
• Repeated attempts for a permanent 'doc fix' highlighted the need for a new payment model.
• The Medicare Access and CHIP Reauthorization Act (MACRA) was enacted to address these issues.

Purpose of the Study:

• To examine the historical context leading to the MACRA legislation.
• To analyze the current pathways within the Quality Payment Program (QPP).
• To explore future expectations for the QPP from CMS, stakeholders, and patients.

Main Methods:

• Historical analysis of legislative efforts preceding MACRA.
• Review of current Quality Payment Program structures and guidelines.
• Synthesis of perspectives from the Centers for Medicare and Medicaid Services (CMS), stakeholders, and patients.

Main Results:

• The QPP evolved from the need to stabilize Medicare physician payments.
• Current QPP pathways offer different tracks for clinician participation.
• Future expectations involve program adjustments based on performance and stakeholder feedback.

Conclusions:

• MACRA and the QPP represent a significant shift in Medicare physician payment policy.
• Understanding the program's history and current structure is crucial for effective participation.
• Ongoing evaluation and adaptation will shape the future of the QPP.