CMS recently has published its final rule about the new Medicare payment methodology for physician services under Medicare Part B or the Quality Payment Program (QPP).
Enacted in 2015, the QPP is part of the Medicare Access and CHIP Reauthorization Act. The effective date is Jan. 1, 2017 for reporting the first year of QPP, while payments will begin in 2019. CMS will accept comments on the final rule through 5 p.m. on Dec. 19, 2016 at http://www.regulations.gov.
The final rule repeals the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule and replaces it with the QPP. The goal is to reward high-quality patient care by eligible clinicians and groups through two options: the Advanced Alternative Payment Model (APM) and the Merit-based Incentive Payment System (MIPS).
Eligible clinicians, who have more than 20% of their Medicare patients in models that qualify as Advanced APMs or who receive 25% or more of their Medicare-covered professional service payments in 2017, can qualify as Advanced APMs and can select the APM track to earn a 5% Medicare incentive payment in 2019. Those who decide to not report data under MIPS in 2017 will receive a negative 4% payment adjustment for that year.
Clinicians eligible for MIPS will need to report for at least 90 continuous days in 2017.
MIPS, a new program for some Medicare-enrolled practitioners, consolidates components of the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record Incentive Program for Eligible Professionals. MIPS will continue CMS’ focus on quality, cost, and use of certified electronic health record technology.
Acknowledging that technology, infrastructure, physician support systems, and clinical practices will change in the near future, CMS said that the QPP will “evolve over multiple years in order to achieve our national goals.”
QPP specifically aims to do the following:
- Support care improvement by focusing on better patient outcomes, decreased provider burden, and preservation of independent clinical practice;
- Promote adoption of alternative payment models that align incentives across healthcare stakeholders, and
- Advance existing efforts of delivery system reform.1
“We solicited and reviewed over 4,000 comments and had over 100,000 physicians and other stakeholders attend our outreach sessions,” CMS said.
Based on feedback, CMS established six strategic objectives, as follows:
- To improve beneficiary outcomes and engage patients through patient-centered APM and MIPS policies;
- To enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools;
- To increase the availability and adoption of robust Advanced APMs;
- To promote program understanding and maximize participation through customized communication, education, outreach, and support that meet the needs of diverse physician practices and patients;
- To improve data and information sharing to provide accurate, timely, and actionable feedback to clinicians and other stakeholders, and
- To ensure operational excellence in program implementation and ongoing development.
MIPS measures quality of care through evidence-based clinical quality measures, selected by eligible clinicians, CMS says.
Also, MIPS accounts for activities that physicians identify, including practice-driven quality improvement.
The final rule also notes that services rendered for outpatients in community settings, including surgery centers, are reimbursed through Part A and are exempt from the Quality Payment Program.
This results in beneficiaries who are less acute and low cost to the Medicare program being excluded in the QPP attribution, CMS noted.
For more information about the final rule, contact Molly MacHarris (about MIPS) at (410) 786-4461 or James P. Sharp (about APMs) at 410-786-7388.
- Medicare program; Merit-based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive under the Physician Fee Schedule and Criteria for Physician-Focused Payment Models. Federal Register. Nov. 4, 2016. http://bit.ly/2ezYCAt.