If trying to understand the acronyms with the new quality payment program and MACRA makes your head spin, consider this your unofficial cheat sheet.
|APM (Alternative Payment Model)||APMs are different ways to organize, provide, and pay for healthcare. Some examples include Patient-Centered Medical Homes (PCMHs) and Accountable Care Organizations (ACOs).¹||MACRA offers different reimbursement models for APMs, including special lump-sum payment incentives that encourage providers to organize APMs. If eligible, providers working through APMs may avoid the financial disincentives associated with MIPS.¹||After initially reporting through MIPS, some practices will become eligible for APM participation.¹|
|CEHRT (Certified Electronic Health Record Technology)||CEHRT is EHR software that meets or exceeds requirements created by the Office of the National Coordinator for Health Information Technology (ONC).²||Certified EHR software is eligible for the Medicare and Medicaid EHR Incentive Programs.²||This program is being replaced under MACRA and will be consolidated along with other programs into MIPS and QPP.¹|
|CPIA (Clinical Practice Improvement Activities)||Activities that improve care are used to determine part of clinical performance. Clinicians are able to choose the metrics included on their scorecard.⁴||Examples of activity metrics include care coordination, safety checklists, emergency preparedness and response, and others.⁴||Participants in MIPS will need to choose activities that work best for their practices.⁴|
|MACRA (Medicare Access & CHIP Reauthorization Act)|| Legislation enacting three significant changes to Medicare, including:¹
1. Eliminates Sustainable Growth Rate (SGR);
2. Creates QPP;
3. Combines quality reporting into a single system.
|Compliance with MACRA is an important issue for any practice accepting Medicare, since reimbursement rates are effected by MACRA participation.
This program is designed to be cost-neutral by funding incentive payments with payment decreases for low-performing practices.¹
|Ultimately, this is an attempt to fix many of the issues with paying for Medicare and maintaining quality of care. Practices that meet or exceed performance metrics may receive incentive payments. Practices that fall short of Medicare’s standards may receive smaller payments.¹|
|MIPS (Merit-Based Incentive Payment System)||New program combining and consolidating previous quality-reporting programs such as PQRS, VM, and EHR Incentive Program. MIPS is one of the two options under QPP.¹||MIPS will measure quality, use of resources, clinical practice improvement, and EHR meaningful use.¹||Practices that do not meet MIPS standards will receive a negative adjustment on all reimbursements from Medicare.¹|
|PQRS (Physician Quality Reporting System)||Existing program allowing eligible professionals (EPs) and practices to report information about care quality to Medicare.³||This program is being replaced by MIPS. Starting in 2015, practices that did not report metrics using PQRS began receiving reimbursement decreases.³||Under MIPS, practices will begin reporting quarterly and will be permitted to choose their own quality metrics.¹,⁴|
|SGR (Sustainable Growth Rate)||Enacted in 1997 as a cost-control measure to limit the growth of payments to physicians.⁴||This program is being replaced by MIPS.¹||Congress will no longer need to pass temporary “fixes” to protect payments from cuts, since SGR is going away.⁴|
|QPP (Quality Payment Program)||This program establishes two reimbursement programs for Medicare based on quality performance. These are MIPS and APM models.¹||Encourages practices to meet quality standards, qualify for incentive pay and participate in APM models.¹||QPP is the name of the program created by MACRA to replace existing payment models.¹|
|VBPM (Value-Based Payment Modifier) or VM (Value Modifier)||Allows for differential payments to practices based on quality performance.⁵||Began in 2015 with larger practices but will soon apply to solo practices too.⁵||Starting in 2017, VBPM will be applied to solo and small practice payments.⁵|
¹CMS. “MACRA: Delivery System Reform, Medicare Payment Reform.” https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html. Accessed: August 2016.
²CMS. “Certified EHR Technology.” https://www.cms.gov/regulations-and-guidance/legislation/ehrincentiveprograms/certification.html. Accessed: August 2016.
³CMS. “Physician Quality Reporting System.” https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqri. Accessed: August 2016.
⁴CMS. “Merit-Based Incentive Payment System: Clinical Practice Improvement Activities Performance Category.” https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/CPIA-Performance-Category-slide-deck.pdf. Accessed: August 2016.
⁵CMS. “Value-Based Payment Modifier.” https://www.cms.gov/medicare/medicare-fee-for-service-payment/physicianfeedbackprogram/valuebasedpaymentmodifier.html#What%20is%20the%20Value-Based%20Payment%20Modifier%20(Value%20Modifier). Accessed: August 2016.