The Centers for Medicare & Medicaid Services (CMS) defines value-based care as those programs that “reward health care providers with incentive payments for the quality of care they give to people with Medicare.” CMS began emphasizing value-based, quality healthcare over the quantity of provider visits in 2008. Since then, additional programs have been put into place that direct the reporting requirements and the payment levels based on certain circumstances.
In 2008, CMS initiated the Medicare Improvements for Patients and Providers Act (MIPPA) which, in part, rewarded eligible healthcare providers for electronic prescriptions. The next year, the Health Information Technology for Economic and Clinical Health Act (HITECH) was included in the American Recovery and Reinvestment Act of 2009 (ARRA). HITECH established programs under Medicare and Medicaid to provide incentive payments to eligible healthcare providers for the “meaningful use” of certified electronic health record (EHR) technology.
The Affordable Care Act (ACA) was implemented in 2010. ACA placed more emphasis on quality care and authorized a number of value-based programs that rewarded healthcare providers based on that quality rather than on quantity. Just a few years later, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) was signed into law as a bipartisan legislation on April 16, 2015.
CMS states that “MACRA created the Quality Payment Program that:
- Repeals the Sustainable Growth Rate formula
- Changes the way that Medicare rewards clinicians for value over volume
- Streamlines multiple quality programs under the new Merit Based Incentive Payments System (MIPS)
- Gives bonus payments for participation in eligible alternative payment models (APMs)”
In recent years, healthcare provider feedback regarding the reporting burdens and complications placed upon them by value-based reimbursement program requirements has caused CMS to re-evaluate some of their initiatives. CMS has launched an Innovation Center supporting “the development and testing of innovative health care payment and service delivery models.” The Innovation Center seeks further input from physicians and other healthcare providers as they test “various payment and service delivery models that aim to achieve better care for patients, smarter spending and healthier communities.”