MACRA of 2015 (P.L. 114-10) defined five quality domains, including (i) clinical care, (ii) safety, (iii) care coordination, (iv) patient and caregiver experience, and (v) population health and prevention. In response to MACRA and the laws it amends, CMS conducts measure priorities planning across these domains and emphasizes (a) outcome measures, including patient-reported outcome measures and functional status measures, (b) patient experience measures, (c) care coordination measures, and (d) measures of appropriate use of services, including measures of overuse.
With MACRA, Congress mandated that several quality reporting and incentive programs phase out in 2018, while MIPS would continue well beyond 2019. Under MACRA, CMS developed performance assessment methods using composite scoring for the determination of MIPS adjustment factors for all MIPS-eligible clinicians. Funding provided under the ACA for the creation of a wide array of quality measures, including outcome measures and measures for settings that are new to quality reporting such as IRFs, hospices, LTCHs, inpatient psychiatric facilities, and Prospective Payment System (PPS)-exempt cancer hospitals, supports this effort. In addition, under MACRA and ACA, Medicaid and other Department of Health and Human Services programs will continue to develop and implement quality measures. MACRA also supports the gains made under ARRA. ARRA launched a period of significant funding for the development of standards for EHRs and the widespread adoption of CEHRT across measured entities. MACRA continues this support with a mandate for widespread interoperability among these systems with requirements for CMS to develop metrics for successful interoperability. Further, MACRA requires incentives and payment penalties to encourage rapid achievement of that goal.