Source: Health Services Advisory Group
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 health care instead of a passive payer for medical services. As the Medicare Quality Innovation Network-Quality Improvement Organization (QIN-QIO) in Ohio, the Health Services Advisory Group (HSAG) provides technical assistance to physicians and other health care providers to help in making this transition to payment for quality.
HSAG’s current work supports physician incentive programs including the Physician Quality Reporting System (PQRS) and Meaningful Use (MU). PQRS serves as the foundation for assessing the quality of care individual or group practices provide through electronic health record (EHR) submission of evidence-based quality measures. However, 2016 is the last year that quality measures and EHR MU attestation is required for providers who bill Medicare FFS. As set out in the MACRA legislation signed into law in April 2015, providers will now submit quality measures to the Merit-Based Incentive Program System (MIPS). MACRA replaces the Medicare Sustainable Growth Rate (SGR) and puts into place two types of quality payment programs Alternative Payment Models (APMs) and MIPS. MACRA streamlines PQRS, MU, and the value-based modifier into one quality program. MIPS requirements mirror the PQRS quality measures (with only six instead of nine required measures) and MU requirements, as well as additional requirements for health information exchange, patient care coordination, and interoperability. Data submission methods remain the same EHR, qualified registry, web interface, clinical data registry, and claims.
Regardless of which data submission method the provider chooses, HSAG is here to provide technical assistance to make the transition to MACRA as smooth and efficient as possible. For more information, contact Vice President Health Information Technology Kimberly D. Harris-Salamone, PhD, MPA, HSAG, or call 602.801.6960.
This material was created by the HSAG the Quality Improvement Organization for Arizona, California, Ohio, Florida, and the U.S. Virgin Islands, under contract with the Centers for Medicare & Medicaid Services (CMS), an agency of the U.S. Department of Health and Human Services. The contents presented do not necessarily reflect CMS policy. Publication No. QN-11SOW-D.1-06292016-02.