Quality & Value

The Medicare Access and CHIP Reauthorization Act (MACRA) legislation will fundamentally change the way Medicare pays clinicians. Understanding this complex new payment program and developing a successful strategy is challenging for many health care organizations, clinicians and staff in Kentucky and across the US.

The Kentucky REC offers a variety of grant-funded and fee-for-service options tailored to the needs of our clients. Click on the boxes and links below or contact us to find out how we can help your organization master MACRA.

The Basics of MACRA

Passed in April 2015, MACRA gave the Centers for Medicare and Medicaid Services (CMS) the authority to create the Quality Payment Program or QPP. MACRA replaced the Sustainable Growth Rate (SGR) cuts with an alternative set of payment policies governing Medicare payments to eligible clinicians. The goal is to move Medicare spending increasingly toward rewarding higher quality and value and away from financial incentives for the volume of services provided.

Eligible clinicians must choose between two tracks: the Merit-Based Incentive Payment System (MIPS) or participating in an Advanced Alternative Payment Model (APM). This choice will determine Medicare Physician Fee Schedule reimbursement rates and methods beginning January 1, 2019.

MACRA creates the Quality Payment Program (QPP) which has two main tracks:

  1. Advanced Alternative Payment Models (APM)
  2. Merit-Based Incentive Payment System (MIPS)

MACRA Timeline

  • October 14, 2016: Release of Year One Final Rule
  • January–December 2017: First Performance Period for MACRA
  • November 2, 2017: Release of Year Two Final Rule
  • March 31, 2018: Reporting Deadline for First Year
  • January-December 2018: Second Performance Period for MACRA
  • March 31, 2019: Tentative Reporting Deadline for Second Year
  • January–December 2019: First Payment Year (+/- 4%)
  • January–December 2020: Second Payment Year (+/- 5%)

Practice Transformation Network

Great Lakes Practice Transformation Network (PTN) is a peer-based learning network that supports 1,938 providers in Kentucky with practice transformation and preparation for Alternative Payment Models (APMs).

Quality Payment Program—Small, Underserved and Rural

Free Quality Payment Program technical assistance for small, underserved, and rural practices of 15 clinicians or less through a CMS contract establishing the QPP Resource Center™, which provides education, resources, tools, live chat and phone support.

MACRA Individualized Assistance

Support for healthcare providers as they navigate the changes under MACRA and Value-Based Payment through personalized education, in-depth gap analysis, action plan, monthly meetings, and attestation support.

Quality Improvement

Guidance, support and tools are available for practices interested in improving their performance on measures of quality & value.