In 2015, the Medicare Access and CHIP Reauthorization Act (MACRA) was passed – and since then, a flurry of health care regulatory terms has emerged. With so many acronyms, the waters can get muddy. Use this list of "MACRAnyms" as a quick guide to help navigate frequently used terms surrounding MACRA and value-based care programs.
MACRA mandated critical changes to Medicare reimbursement – that is, how physicians who provide care to Medicare beneficiaries are paid for their services. Changes include repealing the sustainable growth rate formula, previously used to determine Medicare payments for clinicians’ services; developing a method of rewarding clinicians who provide superior care; and combining existing quality reporting programs into one new system.
The Quality Payment Program is the payment system created via the regulatory process under the MACRA legislation. It outlines two paths for participation: the Merit-based Incentive Payment System (MIPS) and advanced Alternative Payment Models (APMs).
One track of the QPP that combines the EHR Incentive (meaningful use) program, Physician Quality Reporting System (PQRS) and the Quality and Resource Use Report (QRUR) reports, all of which were used previously in separate ways to measure physician quality measures and expenditures into one payment system.
An alternative payment model is a payment program that rewards providers for delivering high-quality care in the most efficient way possible. Advanced alternative payment models comprise the second of two tracks in the MACRA QPP that determine Medicare Part B payment adjustments.
CMS is a division of the Department of Health and Human Services that focuses on administering Medicare and Medicaid programs as well as the Children’s Health Insurance Program and the Health Insurance Marketplace. The new secretary of CMS in President Donald Trump’s administration is Seema Verma.
The Department of Health and Human Services is a cabinet-level department of the federal government, focused on protecting the health of Americans and providing essential human services. Dr. Tom Price is the new secretary of HHS within President Trump’s administration.
Value-based care refers to care delivery that ties payment to the quality of care provided and rewards efficiency and effectiveness.
Also referred to as the EHR Incentive program, the meaningful use program (MU) was created under the Health Information Technology for Economic and Clinical Health (HITECH) Act that was incorporated into the American Recovery and Reinvestment Act of 2009. The program was designed to reward providers and hospitals for implementing and using electronic health records in a “meaningful” way.
Launched in 2012, the Comprehensive Primary Care (CPC) initiative was designed with the goal of strengthening primary care. This four-year, multipayer model ended in 2016 and was the precursor to CPC+.
CPC+ was launched in January 2017. It is the second wave of CPC, designed as an alternative payment model for primary care providers. CPC+ incorporates many of the lessons learned through CPC and seeks to promote care coordination.
An Accountable Care Organization (ACO) is a group of physicians, hospitals and other health care providers who come together voluntarily to give coordinated high-quality care to the patient population they serve.
The Medicare Shared Savings Program (MSSP) is a type of ACO designed to facilitate coordination and cooperation among providers to improve the quality of care for Medicare fee-for-service beneficiaries while reducing unnecessary costs.
The Next Gen ACO enables provider groups to assume higher levels of financial risk and reward than are available under the MSSP, but still requires them to provide high-quality standards of care for Medicare fee-for-service beneficiaries.
The Oncology Care Model (OCM) is designed to improve the effectiveness and efficiency of oncology care for Medicare patients. The model bases payment arrangements on financial and performance accountability for episodes of care surrounding chemotherapy administration for cancer patients.
The Comprehensive Care for Joint Replacement (CJR) program aims to support better and more efficient care for Medicare beneficiaries undergoing hip and knee replacements (also called lower extremity joint replacements, or LEJR). This model “bundles” payment and quality measurement for an episode of care associated with hip and knee replacements to encourage hospitals, physicians and post-acute care providers to work together to improve the quality and coordination of care from the initial hospitalization through recovery.
Similar to the CJR program, an episode payment model (EPM) bundles payment for episodes of care beginning with hospitalization through 90 days post-discharge. Three specific models comprise what is collectively referred to as the “EPMs.”
The Bundled Payments for Care Improvement (BPCI) initiative includes four models of care that bundle payments for multiple services Medicare beneficiaries receive during an episode of care. Unlike CJR and EPMs, the timeframe for each of these models varies.
A Prospective Payment System (PPS) is a method of reimbursement in which Medicare payment is made based on a predetermined, fixed amount. This type of system is already in place for inpatient and outpatient services and is currently under consideration for long-term and post-acute care (LTPAC) venues as well.
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