Historically, medical professionals billed insurance companies based on a preset amount that was the same no matter how well the appointment was handled. Now, the Medicare Access and CHIP Reauthorization Act of 2015 is moving more toward a merit-based system of payments that is meant to reward medical professionals who are excelling in patient care. The Merit-based Incentive Payment System, or MIPS, is the system that is used to handle the MACRA requirements. Ideally, Centers for Medicare & Medicaid Services would like to see 50 percent of traditional payments transitioned to this system by 2018.

MIPS Is a Voluntary MACRA Program

Providers have to voluntarily sign up for MIPS if they want to participate. There are four key areas that are used to measure the quality and efficiency of care. So far, three of the categories, Quality, Improvement Activities and Advancing Care Information, have been implemented into the MACRA requirement formula. Starting in 2018, the fourth, Cost, will be implemented into the MACRA measures formula.

Goal of the Program

Traditional fee-for-service payments encourage doctors to focus on the number of patients they can funnel through the system each day. This can lead to a low quality of care, which means that the patients might not have enough time to ask questions that can help them to understand their diagnosis or treatment plan. It also means that doctors might miss important points during the time with the patient.

The MACRA MIP program is meant to help doctors slow down a bit to focus on the quality of care without forcing patients to wait prolonged periods for appointments. The program uses tangible measures to determine how a doctor is performing. Doctors who are doing well, meeting benchmarks and making necessary improvements can enjoy higher pay rates, while doctors who aren’t faring well have an incentive to improve.

Alternative Payment Models

As part of the MIPS MACRA system, some clinicians are eligible for the Alternative Payment Models programs. These further reward doctors who deal with specific conditions, populations or care episodes if the benchmarks are met. The rewards for this program are tiered with a minimum patient count required to get the maximum payment. Clinicians who are eligible for the program in 2017 and meet the requirements will see a 5 percent APM incentive payment in 2019.