The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) is intended to rapidly push the transformation of the US healthcare system toward performance-based payment models across both government and commercial payers. The law provides strong incentives to physicians for participation in Medicare risk-sharing Alternative Payment Models (APMs). For physicians who choose not to become involved in APMs, they will be required to report and perform well on four categories – quality, resource use, health information technology use, and clinical practice improvement – in the new Merit-based Incentive Payment System (MIPS).
Bearing risk and reporting on clinical performance requires the ability to collect, analyze and report on clinical performance data. Whether it is identifying high cost patients, reducing readmissions and adverse events, coordinating care and managing resource use, or accurately reporting quality measures to various registries and payers, clinicians will need to make better use of health information technology to help them avoid financial penalties and allow their practices to prosper in the new environment.