Medicare has developed a new incentive payment framework (“MACRA”) which is intended to fundamentally change the way in which the Federal Government evaluates and pays for the healthcare services that are provided to Medicare beneficiaries. It is designed to move us away from a volume-based “fee-for-service” reimbursement system to one which emphasizes the quality of the care provided. The new reimbursement program is scheduled to begin on January 1, 2017.
To avoid penalties and qualify for bonuses under MACRA, physicians must participate in the new Merit Based Incentive Payment System (MIPS, for short) unless they have a substantial amount of their revenue at risk under a qualifying alternative payment model (“APM”) — and the vast majority of physicians do not.
Physicians were supposed to start reporting performance data next year, and many complained that smaller practices in particular wouldn’t be ready. The framework calls for them to choose from an array of measures in four categories: 1. quality; 2. resource use; 3. clinical practice improvement; and 4. meaningful use of electronic health records.
In response to such complaints, CMS Acting Administrator Andrew Slavitt recently announced plans to provide some flexibility to physicians complying with the MACRA Medicare value-based payment programs scheduled to begin at the start of the new year. While the final rule will not be released until later this fall, CMS announced that such regulations will exempt physicians from any risk of Medicare payment penalties for 2019 within the MIPS program if they choose one of three distinct reporting options in 2017, in addition to the option of participating in an advanced APM:
* Full-year reporting that begins on January 1;
* Partial year reporting for a reduced number of days; and
* A “test” option under which physicians can report minimal amounts of data.
Physicians who report in 2017 may be eligible for bonus payments in 2019, depending on which option they choose. Those who opt for full-year reporting will be eligible to receive a “modest positive payment adjustment;” and those who choose partial year reporting will be eligible for a “small positive payment adjustment.” Physicians who choose the “test” option will not be eligible for a bonus, but also not subject to any payment penalties. Qualified participants in advanced APMs will be eligible for a 5 percent incentive payment in 2019.
AMA President Dr. Andrew Gurman applauded CMS “for listening to physicians’ concerns about the timeline that was originally proposed for MACRA”. He stated, “By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA. This approach better reflects the diversity of medical practices throughout the country. The AMA believes the actions that the Administration announced today will help give physicians a fair shot in the first year of MACRA implementation.”
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