Global Point of Care
Global Point of Care
The Medicare Access and CHIP Reauthorization Act of 2015, or MACRA, is a bipartisan legislation signed into law on April 16, 2015. MACRA created the Quality Payment Program (QPP), allowing Medicare to reimburse providers for the value of their services, as opposed to a Fee for Service (FFS) care structure, which allowed providers to be reimbursed for the volume of services provided.
MACRA repeals the Sustainable Growth Rate (SGR) formula, changing the way clinicians are reimbursed for services, allowing bonus payments (in alternative payment models) based on the quality of care. Under MACRA, providers are further incentivized to achieve “Quadruple Aim” goals (reducing cost of care, improving population health, enhancing patient experience, and improving provider well-being). According to a study, HbA1c testing 4x/year may reduce HbA1c levels, leading to better management of diabetes and reduction of health care costs.1 Given that CMS (Centers for Medicare & Medicaid) is aligned with MACRA as the largest payer in the US, incentivizing better outcomes may drive positive change for patients and clinicians alike.
It is important to note that MACRA is focused on traditional Medicare, not Medicare Advantage, which are commercial health plans that administer Medicare. The QPP is separated into two major tracks for providers:
MIPS is composed of 4 categories and allows clinicians to choose measures and activities that are relevant to their practice. The MIPS Composite Performance Score is used to calculate provider payments. The 4 MIPS categories include:
MIPS categories are reported to CMS as a composite score that determines the level of reimbursement for a provider. The maximum CMS Medicare payment adjustments a clinician can achieve are ±9%. This means a MIPS-eligible clinician who does not participate in MIPS in 2022 will receive a negative payment adjustment of -9% in 2024.2
Alternative Payment Models (APMs) are normally for larger provider groups, as those providers assume more financial risk in the management of their patient populations. APMs have similar quality measures as MIPS and there are several APM options providers may select. The Medicare Shared Saving Program (MSSP) is one of the most well-known APMs and has several reimbursement tracks to incentivize providers. MSSP has a quality component that reimburses providers to achieve quality metrics, such as HbA1c control, statin therapy, and patient satisfaction. In many cases, a reduction in health care costs can equate to millions of dollars that are shared with the ACO/Provider.
For example, over the last 3 years their performance was measured, Baylor Scott White, the largest ACO in the nation, received over $100 million dollars in CMS MSSP bonus payments.3
This article is one of a series of value-based, health care policy, and population health topics specific to diabetes and CVD topics that we plan to introduce to our providers. Our next topic in this series will be on Medicare Advantage that will include STARs, risk adjustment, HEDIS, CAHPs, etc.
A Leader in Rapid Point-of-Care Diagnostics.
©2023 Abbott. All rights reserved. Unless otherwise specified, all product and service names appearing in this Internet site are trademarks owned by or licensed to Abbott, its subsidiaries or affiliates. No use of any Abbott trademark, trade name, or trade dress in this site may be made without the prior written authorization of Abbott, except to identify the product or services of the company.
This website is governed by applicable U.S. laws and governmental regulations. The products and information contained herewith may not be accessible in all countries, and Abbott takes no responsibility for such information which may not comply with local country legal process, regulation, registration and usage.
Your use of this website and the information contained herein is subject to our Website Terms and Conditions and Privacy Policy. Photos displayed are for illustrative purposes only. Any person depicted in such photographs is a model. GDPR Statement | Declaration for California Compliance Law.
Not all products are available in all regions. Check with your local representative for availability in specific markets. For in vitro diagnostic use only. For i-STAT test cartridge information and intended use, refer to individual product pages or the cartridge information (CTI/IFU) in the i-STAT Support area.
Abbott - A Leader in Rapid Point-of-Care Diagnostics.