MACRA: background, opportunities and challenges for the neurointerventional specialist

Abstract

The legislative branch of government took many by surprise when it announced the Medicare Access and CHIP Reauthorization Act of 2015. Once the Act was passed, President Obama quickly signed this bipartisan, bicameral effort into law. A foundational element of this legislation was the permanent repeal of the sustainable growth rate formula. Physicians and their patients were appropriately enthusiastic about this development. The Medicare Access and CHIP Reauthorization Act of 2015 included additional elements of considerable interest to neurointerventional specialists.

PQRS and the MACRA: Value-Based Payments Have Moved from Concept to Reality

“…1 This bipartisan legislation left little doubt about the value-oriented future of health care in the United States during 2015-2021 and beyond. 22,23 The MACRA attempts to align various preexisting performance programs, consolidating aspects of the PQRS, Value-Based Payment Modifier Program, and the Meaningful Use initiative with which many readers will be familiar. The MACRA defines 2 methods for payment to enable the transition toward the goal of paying for better care value.…”

“…Because QCDRs support multiple components of MIPS for the same activity, they feature prominently in MACRA. 22 The transparency of this quality effort will also evolve. Since the 2013 performance period, CMS has been providing EPs and groups with confidential feedback reports: Quality and Resource Use Reports (QRUR) that allow PQRS participants to compare themselves with other groups of providers on the basis of specific episodes of care.…”

“…An additional $500 million is potentially available from calendar years 2019 to 2024 for individual providers or groups that perform exceptionally well. 22 For providers, therefore, there is great financial incentive to both deliver and document quality care. It is important to initiate efforts to meet these requirements in a timely and thoughtful manner, to maximize the chance of practice success.…”

The episode, the PTAC, cost, and the neurointerventionalist

“…As outlined previously, it pushed forward the agenda of transforming the FFS volume-based US healthcare delivery system into one that is value-driven 9 10. An important component of MACRA was expansion of episode groups, representing sets of all rendered services relating to a given clinical condition or diagnosis.…”

Health Care Economics: A Study Guide for Neuroradiology Fellows, Part 2

“…QCDR is a CMS-approved construct that allows the tracking of patients and disease via the collection of medical/clinical data, thereby fostering enhancement in the quality of care provided to patients. 16 The National Radiology Data Registries of the American College of Radiology have successfully received QCDR status, along with many other specialty societies. QCDR allows members of these societies the option of using specialty-specific data to comply with MIPS in a system that complies with all 4 MIPS performance categories discussed above.…”