MACRA & The Quality Payment Program (QPP)

The Medicare Access and Chip Reauthorization Act of 2015 (MACRA) is bipartisan legislation established to reform Medicare payments.  The Department of Health and Human Services along with the Centers for Medicare and Medicaid have been engaged in the process of drafting rules based on the legislation since the law passed.  The new Quality Payment Program is designed to improve health outcomes while lowering the cost of healthcare. It is an integral part of the transition towards value and quality.

MACRA repeals the old Sustainable Growth Rate (SGR) formula for determining Medicare payments, and combines existing quality reporting programs into one new system.  Eligible clinicians can select to participate in one of two tracks in the Quality Payment Program, the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs). These changes will dramatically affect clinicians, hospitals, and healthcare organizations in different ways.

For national resources available through the American Hospital Association click here.

In our state, the Office of Rural Health (ORH), the Carolinas Center for Medical Excellence (CCME), SCHA and others are providing tools, resources, and programs to assist hospitals, physician practices, and clinicians prepare for MACRA.
 
Below is a guide to state resources that are available depending on your needs.

Are you currently or interested in becoming a Patient-Centered Medical Home?

The Office of Rural Health is leading the efforts of the SC PCMH Alliance in supporting MACRA education, training, and resources.

For more information, contact:
Michelle Stanek
stanek@scorh.net
803.454.3850

Are you a rural hospital, small rural practice (fewer than 15 physicians), or a Rural Health Clinic (RHC)?

The Office of Rural Health provides direct technical assistance and coordinates and conducts learning opportunities and resources on MACRA and the Quality Payment Program (QPP). ORH is funded through the Georgia Medical Care Foundation by CMS to support SC small practices (<15 physicians) to navigate the new lad and program. MACRA currently exempts RHCs, FQHCs and low-volume Medicare providers; however, we encourage all providers to begin educating themselves about MACRA, particularly the Merit-based Incentive Payment System (MIPS) requirements, in anticipation of the continued move towards value-based payments. ORH will also provide linkage and support related medical home development and other practice transformation efforts and pay-for-value initiatives in SC.

For more information, contact:
Michele Stanek
stanek@scorh.net
803.454.3850

Are you a large hospital or hospital system or a practice with more than 15 physicians?

The Carolinas Center for Medical Excellence is one of the 14 Medicare-funded Quality Innovation Network-Quality Improvement Organizations (QIN-QIO) and is leading efforts to support the Quality Payment Program (QPP) instituted by MACRA. CCME offers direct technical assistance, educational resources for clinicians, and additional learning opportunities.

For more information, contact:
Amorette Raymes
sc-qpp@atlanticquality.org
1.800.922.3089 ext. 7534.



Resources

CMS Quality Payment Program
AHA MACRA page
CMS Path to Value Presentation
5 Things to Take Away from the MACRA Final Rule
CMS MACRA Page
Quality Payment Program Fact Sheet
AHA MACRA Issue Brief