The main innovation under the Medicare Access and CHIP Reauthorization Act (MACRA) is that payment for medical services is based not on workload but on value to the patient. Under this system, there are two types of financial incentives for healthcare professionals: the Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs). Both individual healthcare providers and “groups within the same tax identification number” can qualify for payments (Cheng et al., 2020, p. 27). However, MIPS and APMs have different eligibility criteria for healthcare professionals.
First, most fee-for-service providers can qualify for MIPS. It is the most common system, according to which health workers and the services they provide are evaluated on a 100-point scale, taking into account “quality, cost, improvement activities, and promoting interoperability” (Cheng et al., 2020, p. 27). Secondly, a mandatory criterion for MIPS is that the process lasts three years. In the first year, data is collected for evaluation; after that, providers receive feedback; in the third year, health workers receive financial incentives or fines. Physicians, assistants, nurse practitioners, clinical nurses, or groups of these professionals may qualify for incentives. Finally, individual providers must select six quality measures for evaluation, while groups of providers must determine six quality measures and two outcome measures.
Healthcare providers who refuse to qualify for MIPS under MACRA can use The Advanced Alternative Payment Models to receive a reward. First, this category includes providers whose activities are carried out within the framework of a two-sided nominal financial risk and whose actual costs are less than expected (Cheng et al., 2020). In this case, providers can receive a financial incentive of 5% through Medicare savings. In addition, Cheng et al. (2020) note that “most advanced APMs focus heavily on care-coordination and comprehensive care” (p. 30). Therefore, in the first place, specialists who specialize directly in patient care can apply for a bonus under these models.
Reference
Cheng, J., Kim, J., Bieber, S. D., & Lin, E. (2020). Four years into MACRA: what has changed? Seminars in dialysis, 30(1), 26-34. Web.