The signing into law of the Medicare Access and CHIP Reauthorization Act of 2015 MACRA redefined Medicare reimbursement in the United States, in large part doing away with the longstanding fee-for-service payment model and replacing it with a value-based system focused on quality patient outcomes—one that not only puts the emphasis on patient care but also allows for more efficient health care spending overall.

Under the new legislation, eligible clinicians (ECs) will choose one of two reimbursement options based on key factors such as specialty and patient population. The first is the merit-based incentive payment system (MIPS), which combines aspects of the meaningful use/electronic health record (EHR) incentive program, the physician quality reporting system (PQRS), and the value-based payment modifier (VBM).

The second option is an alternative payment model (APM). APMs were created under the Patient Protection and Affordable Care Act and represent the movement toward reimbursement based on quality of care. While some APMs may be subject to MIPS performance measures, advanced alternative payment models (AAPMs) may exempt qualified providers from MIPS guidelines as well as increase Medicare reimbursements.

For payer organizations, the shift from a volume- to a value-based system is likely to present a challenge in terms of effectively tracking patient health data throughout the continuum of care. Because reimbursement is based on measurable patient outcomes, accurate reporting is imperative. Changes in current technology will be necessary to allow for the rapid exchange of information between care providers at every stage. Are you prepared?