CMS and Performance Measure Implementation: Understanding the Impact of the "2-Year Look Back" and "Capping Out"

As health care changes, performance measures are  playing an increasing role in the care provided, how that care is perceived,  and how orthopaedic surgeons get reimbursed. The 2015 Medicare Access and CHIP  Reauthorization Act (MACRA) did away with the Sustainable Growth Rate formula  and the Physician Quality Reporting System (PQRS), but replaced the latter with  the Merit-Based Incentive Payment System (MIPS). As a result of MIPS and the  upcoming change in payment structure, performance measures will be used to  identify top performers and provide financial reward at the expense of  bottom-performing providers, ensuring budget neutrality for the Centers for  Medicare & Medicaid Services (CMS).

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