MACRA’s Chosen One: PCMH (and PCSP, too)

August 25, 2016 · Amy Maciejowski

If you’ve been keeping up with our blog, you know that NCQA has a special interest in MACRA. Each week, we pinpoint a topic outlined in CMS’ final proposed rule for MACRA’s new payment system.

This week we talk about practices that should perform well on quality measures and that make the cut for quality bonuses—practices with PCMH and PCSP recognition. These practices are given some of the extra support[1] they need within MACRA.

Why does CMS put its faith in the medical home delivery model? Because it works. Practices transform through a recognition program that can make primary and specialty care into what patients want it to be.

MACRA requires “PCMH and PCSP recognition from a widely used, third-party program that is national in scope.” Practices that have earned recognition receive automatic full credit in the Merit-Based Incentive Payment System (MIPS) Clinical Practice Improvement Activities (CPIA) category. Automatic credit for CPIA makes up 15% of the MIPS score that determines whether clinicians get bonuses or penalties. The MIPS categories give the medical home model more of the attention it deserves.

More Than Automatic Credit

NCQA PCMH and PCSP are the leading recognition programs. Recognized practices are not only eligible to earn autocredit, they are positioned to do well in other MIPS categories of clinical quality, resource use and health IT. That’s because PCMHs and PCSPs have already been focusing on these top priorities to earn NCQA Recognition.

MACRA will further the spread of value-based care, which means great things for patients across the country. Did we mention we’re excited about that?

[1]To discover available support in your area, consult NCQA’s newly released Resource Directory.