On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final rule with detailed regulations to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. This law repealed the flawed Medicare Sustainable Growth Rate (SGR) formula and replaced it with a new Quality Payment Program (QPP).
The QPP program has two pathways for covered providers to choose in order to avoid a negative payment adjustment in 2019. Providers may participate in 1) Merit-Based Incentive Payment System (MIPS) or 2) Alternative Payment Model (APM).
Under the final rule, providers may choose to participate in MIPS and start between January 1, 2017 and October 2, 2017, depending on the level of provider readiness. Providers may report just one quality measure, 90 days of data, or a year of data. Payment adjustments will be made according to the option chosen. All reporting of performance data must be complete by March 31, 2018.
If a provider has joined an Advanced Payment Model, there is an opportunity to earn a five percent bonus payment in 2019. Of note, CMS is looking to broaden APMs to include participation by medical specialists and small practices.
We urge all members to review the comprehensive CMS Executive Summary of this final rule and the accompanying CMS Fact Sheet, as placed on the new Medicare Quality Payment Program website.
SCCT will continue to review this proposed rule and highlight additional resources as they become available.