Projects

Rewarding High Quality Patient Care: The Medicare Access and CHIP Reauthorization Act of 2015

2016-2021
Prepared For

U.S. Department of Health and Human Services, Center for Medicare & Medicaid Innovation

To reward the delivery of high quality patient care, President Barack Obama signed the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) into law. MACRA created two Medicare payment pathways for eligible clinicians under the Quality Payment Program.

The Merit-Based Incentive Payment System (MIPS) ties fee-for-service Medicare reimbursements to quality and value and consolidates components of three existing Centers for Medicare & Medicaid Services programs: the Physician Quality Reporting System, Physician Value-Based Payment Modifier, and Medicare Electronic Health Record Incentive Program. The Advanced Alternative Payment Models (APMs) provide incentives to eligible clinicians who deliver high quality and cost-efficient care through participation in Advanced APMs.

To support the Centers for Medicare & Medicaid Services’ efforts to enhance the value of health care services provided to Medicare beneficiaries under the Quality Payment Program, Mathematica and our partner, RTI International, are providing data analytics support and technical assistance in the following ways:

  • Developing and implementing a method to determine, on an annual basis from 2019–2024, the Qualifying APM Model Participants who are eligible to receive a lump sum incentive payment equal to 5 percent of covered professional services from the previous year
  • Conducting assessments of new APMs to determine whether they meet the criteria for advanced status
  • Conducting reviews of physician-focused payment models that have submitted reports to the Physician-Focused Payment Technical Advisory Committee
  • Developing and implementing a method to determine MIPS-eligible clinicians
  • Developing quality scoring methodology for MIPS APM participants
  • Monitoring of fraud, waste, and abuse 

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