MACRA and MIPS

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Centers for Medicare and Medicaid Services

The Medicare Access and CHIP Reauthorization Acot of 2015 (MACRA):
Delivery System Reform, Medicare Payment Reform

What's the Quality Payment Program?

The Quality Payment Program makes Medicare better by helping you focus on care quality and the one thing that matters most – making patients healthier. The Quality Payment Program ends the Sustainable Growth Rate formula and gives you new tools, models, and resources to help you give your patients the best possible care. You can choose how you want to take part based on your practice size, specialty, location, or patient population.

The Quality Payment Program has 2 tracks you can choose from:

1. The Merit-based Incentive Payment System (MIPS)

2. Advanced Alternative Payment Models (APMs)

Using Data from Quality and Resource Use Reports (QRUR) to Prepare for the CMS Quality Payment Program

Primary care practices are preparing for changes that are occurring with the implementation of the  CMS Quality Payment Program (QPP)   Lauren Capizzo, MBA, PCMH CCE, Senior Manager with Healthcentric Advisors, presented at the November Practice Reporting Committee  on the topic “Transitioning to Quality Payment Program: How QRUR’s Can Help you Prepare”. Quality and Resource Use Reports (QRUR) provide comparative information for non-FQHC providers so that physicians can see examples of the clinical care their patients receive compared to average care and cost of other physicians.  The presentation provided directions for practices on how to access QRUR reports through the Enterprise Data Management Account.  These reports provide practices with data they can use now to look for trends to better plan support and care coordination.  Information  is additionally available to practices on costs associated with providers outside of their tax identification number (TIN) on their attributed beneficiaries.  Such information on cost and quality can be used by practices to implement quality improvement strategies to support high risk patient groups and prepare for Merit-Based Incentive Payment Systems (MIPS) and Advanced Alternative Payment Models.  Included in the presentation are links to other resource information.  Healthcentric Advisors (HCA) is available to assist practices with QRUR data access and use (lcapizzo@healthcentricadvisors.org).  

Local MACRA Resources
  • RIQI offers hands-on assistance for MACRA reform.  Through a grant from CMS, RI Quality Institute can help you succeed with the payment reform at no cost to your practice. More information is attached.
  • The New England QIN-QIO is offering a phone-in presentation, Quality Payment Program Final Rule MLN Connects® Call, Tuesday, November 15, 1:30 to 3:00 pm. Register here.

Our Mission

The mission of the Care Transformation Collaborative is to lead the transformation of primary care in Rhode Island in the context of an integrated health care system; and to improve the quality of care, the patient experience of care, the affordability of care, and the health of the populations we serve.