MACRA: RWJBarnabas Health Partners

What is MACRA?

The Medicare Access and CHIP Reauthorization Act of 2015

Repeals the Sustainable Growth Rate (SGR) formula for determining Medicare payments for the healthcare providers’ services and replaces it with a new value-based system called the Quality Payment Program. This program combines the existing quality reporting programs into one new system and changes the way that Medicare rewards clinicians for value of care over volume.

How does the new Quality Payment Program (QPP) relate to participation in the ACO?

Participants in the Barnabas Health Care Network Medicare Shared Savings Program (MSSP) or RWJ Partners MSSP qualify for the Alternative Payment Model (APM) track under MACRA which rewards providers for delivering high quality and cost efficient care. Designated as Track 1 ACOs, Barnabas Health Care Network and RWJ Partners are subject to the MIPs APM scoring standard, thus receiving a composite performance score (CPS) at the ACO level. This score factors in performance in 4 weighted categories on a 0-100 point scale:
  • Quality
  • Cost
  • Clinical Improvement Activities
  • Advancing Care Information

Providers enrolled in either ACO will satisfy MIPS Quality reporting requirements upon completion of quality reporting performed by the ACO. Please note that ACO providers will be responsible for satisfying the Advancing Care Information performance reporting requirement on their own, and the cost category does not take effect until 2018.

CMS has published fact sheets to help further explain the intersection of the Quality Payment Program and the Shared Savings Program, highlighting the following:
  • How the Shared Savings Program and QPP align reporting requirements for ACOs and Merit-based Incentive Payment System (MIPS) eligible clinicians
  • How quality data is reported, used and applied under both the Shared Savings Program and QPP
  • How certain Shared Savings Program tracks meet Advanced Alternative Payment Model (APM) criteria under the QPP
  • How the special APM scoring standard is applied to MIPS APMs.