Medicare Access and CHIP Reauthorization Act's Impact on Palliative Care
Tuesday, February 7, 2017
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Section: Public Policy and Advocacy




The Medicare Access and CHIP Reauthorization Act (MACRA) expedites Medicare’s transition to value-based purchasing (VBP) by linking eligible clinicians to bonuses and penalties based on their quality performance relative to their peers. Eligible clinicians include physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who bill Medicare Part B for more than $30,000 and see more than 100 Medicare patients annually.
 
Palliative Care and MACRA’s Merit-Based Incentive Payment System
 
MACRA’s Quality Payment Program (QPP), which went into effect January 1, 2017, created two payment tracks: Merit-Based Incentive Payment System (MIPS); and the advanced alternative payment models (Advanced APMS). The vast majority of clinicians will participate in the MIPS in the first year. Under MIPS, CMS will calculate payment adjustments based on performance in four categories:
  1. Quality
  2. Cost
  3. Advancing care information
  4. Improvement activities
The eventual weighting of the Quality and Cost categories in the composite score used to adjust provider reimbursement creates a compelling rationale to involve palliative care specialists in the care of seriously ill patients:
  • Quality
Palliative care specialists manage symptoms and stress while patients undergo complex treatments, and support informed decision-making as chronic illnesses progress. This improves the patients’ experience of care as demonstrated previously through significant improvement in satisfaction scores. Therefore, the inclusion of palliative care should improve results on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) for MIPS surveys, which is expected to be one of the more popular “cross-cutting measures” under the quality category. Additionally, the provision of palliative care should help improve performance on a number of other proposed MIPS measures including advance care planning, pain assessment and follow-up, and medication reconciliation.
  • Cost
The significant impact of palliative care in reducing emergency department, hospital, and ICU utilization in seriously ill patients will benefit treating clinicians in their resource use calculations. Efficient resource use is also a key factor determining provider payments in all of the advanced alternate payment models.
 
Opportunity for Palliative Care Under Advanced Alternative Payment Models
 
Palliative care has demonstrably shown to improve the quality of care and the quality of life for seriously ill patients. From a health system perspective, palliative care helps avoid unnecessary utilization and health care costs. As these are significant measures under Advanced APMS, teaming with palliative care providers for health systems and accountable care organizations (ACOs) will allow these organizations to meet their goals and qualify for the five percent bonus payments on top of their Part B billing.
 
VNAA will discuss MACRA’s impact on palliative care at the next Hospice Roundtable. Please contact Joy Cameron to register for that call.
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