MACRA: New Opportunities For Medicare Providers Through Innovative Payment Systems

Today, almost 60 million Americans are covered by Medicare — and 10,000 become eligible for Medicare every day.

For many years, Medicare was primarily a pure fee-for-service (FFS) payment system that paid health care providers based on the volume of services they delivered, not the value of those services. Over time, this contributed to increased costs with little improvement in the quality of care.

However, that system is changing as we work to improve our nation’s health care delivery system to ensure patients and their families receive the best care possible. And, we want to hear from you. Today, the Centers for Medicare & Medicaid Services (CMS) released a Request for Information (RFI) to seek public comment related to new provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and a physician-focused payment model (PFPMs).

Driven by the Affordable Care Act, CMS has taken substantial steps toward this better, smarter, and healthier system through quality improvement programs, promotion of electronic health record use, Accountable Care Organizations (ACOs), Patient Centered Medical Homes, bundled payment models, and other Alternative Payment Models (APMs) developed at CMS.

Driving CMS further along the path to value, in January 2015, Secretary Burwell set goals for 30 percent of traditional Medicare payments to be tied to APMs, such as bundled payments, ACOs, or medical homes, by the end of 2016, and 50 percent of such payments to be tied to these models by the end of 2018.