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Hot Topics: Physician Quality Reporting System (PQRS) and Medicare Access and CHIP Reauthorization Act (MACRA)

February 28, 2017 by Michael Malejko, Marketing Manager

Dr-250x179.pngWith each passing year, the health care industry becomes increasingly dynamic and intricate. While thousands of tiny pieces move in polarizing directions, it is imperative that all team members from the bottom to the top operate within the same standards and goals.

In order to keep all teams operating within the appropriate guidelines, there are a number of governing rules, policies and procedures in every health care setting. Some are hospital mandated, some are mandated on the local level and many are mandated by the federal government.

Today, we’d like to talk about one of the hot topics floating around the health care industry: The Physician Quality Reporting System (PQRS) and Medicare Access and CHIP Reauthorization Act (MACRA). These are just two of the many systems in place outlining standards and goals for health care organizations across the country.

The Centers for Medicare & Medicaid Services (CMS) recognize quality improvement as a top priority in health care. Within PQRS, measures are defined to help track the level of care being provided to patients. “They are tools that help CMS measure or quantify health care processes, outcomes, patient perceptions, and organizational structure and/or systems that are associated with the ability to provide high-quality health care and/or that relate to one or more quality goals for health care. These goals include: effective, safe, efficient, patient-centered, equitable, and timely care” says the Centers for Medicare and Medicaid Services. Failure to report or meet the minimum performance rate (applicable for registry/claims reporting mechanisms) results in a negative payment adjustment. Overall, the program sets out to hold providers accountable for the level of care they provide to their patients. 

2016 was the final year of PQRS as a standalone filing process. In 2017, MACRA will take aim at delivering value-based Medicare payments by incorporating features from several currently existing programs. MACRA will set to change the way health care is paid for in the United States by encouraging the shift from payments based on services to payments based on the quality of care provided.  In order for these changes to be implemented smoothly, technology will have to keep pace with CMS requirements for capturing and providing data. Providers and groups who can keep up with the quickly changing regulations have an opportunity for incentives; whereas, penalty adjustments will apply for those who do not meet minimum standards.
 
There has been some backlash from these types of programs in the past related to the technological willingness and general buy-in of individual providers/groups. Many people wonder whether certain technological features required by law would have been developed in the market if not for the creation of programs like PQRS, Meaningful Use, and now MACRA.

The most important thing to note is that there is full-fledged support to increase the overall quality of care patients are receiving by using high functioning systems across the health care landscape. CMS is still working through the details on how to hold providers accountable for the level of that care they’re providing and MACRA is the newest formulation of that initiative.

Sources: 
https://www.cms.gov/newsroom/mediareleasedatabase/fact-sheets/2015-fact-sheets-items/2015-09-09.html
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/PQRS/index.html?redirect=/pqrs
https://www.cms.gov/Medicare/Quality-Initiatives-Patient-Assessment-Instruments/Value-Based-Programs/MACRA-MIPS-and-APMs/MACRA-MIPS-and-APMs.html