The Patient Protection and Affordable Care Act (ACA) of 2010 was landmark legislation that created the National Quality Strategy (NQS) and which included the redesign of Medicare’s fee-for-service (FFS) payment structure. Medicare revised the NQS with the express purpose of becoming an active purchaser of quality healthcare, instead of a passive payer for medical services. As the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) in Ohio, Health Services Advisory Group (HSAG) works with providers to assist in making this transition to value based payment for quality healthcare seamless and transparent.
HSAG’s current work supports physicians’ incentive programs, including the Physician Quality Reporting System (PQRS) and Meaningful Use (MU). PQRS serves as the foundation for documenting the quality of care individual or group practices are providing through submission of evidence-based quality measures via their electronic health record (EHR). 2016 will be the last year that quality measures and EHR MU attestation is required for providers who participate in Medicare Fee for Service (FFS) billing. As set forth in the new Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), legislation which replaces the Medicare Sustainable Growth Rate (SGR), MACRA streamlines PQRS, MU, and the value-based modifier and puts into place two types of quality payment programs: Alternative Payment Models (APMs) and the Merit-based Incentive Program System (MIPS). Most providers will submit quality measures and attest via MIPS while APMs will have their own reporting options depending upon the specific model being utilized.
MIPS requirements mirror the PQRS quality measures but include six instead of nine required reportable measures, the MU requirements, and additional requirements for health information exchange, patient care coordination, and EHR interoperability. Data submission methods remain the same: EHR, qualified registry, Web Interface, clinical data registry, and claims. Regardless of which method the provider choses, HSAG remains ready to provide technical assistance in making the transition to Value Based Payment as smoothly and efficiently as possible.