The HHS issued a new proposed rule, which is the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015.
Here are eight things to know:
1. Through MACRA, Congress streamlined various programs — such as the Physician Quality Reporting System and the Value Modifier Program — into a single framework to help clinicians transition from payments based on volume to those based on value.
2. The unified framework is called the Quality Payment Program, which includes two pathways: The Merit-based Incentive Payment System and Advanced Alternative Payment Models.
3. Most Medicare clinicians will initially participate in the Quality Payment Program through MIPS. MIPS will allow Medicare clinicians to be paid through success in four performance categories — quality, advancing care information, clinical practice improvement activities and cost. In the first year:
• Quality will account for 50 percent of total score
• Advancing care information will account for 25 percent of total score
• Clinical practice improvement activities will account for 15 percent of total score
• Cost will account for 10 percent of total score
4. CMS will begin measuring performance for clinicians through MIPS in 2017, with payments based on those measures going into effect in 2019.
5. Alternatively, Medicare clinicians who participate to a sufficient extent in Advanced Alternative Payment Models will be exempt from MIPS reporting requirements and qualify for financial bonuses.
6. Alternative payment models include the new Comprehensive Primary Care Plus model, the Next Generation ACO model, among others.
7. However, not all clinicians who participate to some extent in Alternative Payment Models will meet the law's requirements for sufficient participation in the most advanced models.
8. HHS is accepting feedback on the proposal until June 27, 2016.