Feds Issue Landmark New Physician Reimbursement Final Rule

macra-logoThe US Department of Health & Human Services (HHS) issued the final rule for the landmark new payment system for Medicare clinicians last Friday, Oct. 14. The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) Quality Payment Program (QPP) is designed to accelerate the health care system’s move toward value-based payment.  MACRA replaces the flawed Sustainable Growth Rate (SGR) formula.

“Today, we’re proud to put into action Congress’s bipartisan vision of a Medicare program that rewards clinicians for delivering quality care to their patients,” said HHS Secretary Sylvia M. Burwell. “Designed with input from thousands of clinicians and patients across the country, the new Quality Payment Program will strengthen our health care system for patients, clinicians and the American taxpayer.”

The 2,204-page rule is informed by a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments. A common theme in these comments was the need for flexibility, simplicity, and support for small practices. The final policy aims to provide such flexibility, simplicity and support. For instance, the clinicians may now pick one of two pathways depending on what is right pace for them to transition from a fee-for-service health care system to one that uses alternative payment models that reward quality of care over quantity of services. Read the article in the last issue of the NCMS Bulletin to learn more about these options.

With the announcement of the final rule, HHS launched a new Quality Payment Program website, which explains the new program and helps clinicians easily identify the measures most meaningful to their practice or specialty. A service center available by email (QPP@cms.hhs.gov) and phone (1-866-288-8292) will answer questions about the Quality Payment Program.

The Centers for Medicare and Medicaid Services (CMS) will hold a webinar on the final rule next Wednesday, Oct. 26, from 2-3pm. Register for the webinar here. A call with CMS will be held on Tuesday, Nov. 15 from 1:30 to 3 pm. To register or for more information, visit MLN Connects Event Registration. Space may be limited, register early.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) ends the sustainable growth rate and moves Medicare closer to a system that pays physicians based on the outcomes that matter to patients. The Quality Payment Program allows clinicians to choose the best way to deliver quality care and to participate based on their practice size, specialty, location, or patient population. During this call, learn about the provisions in the recently released final rule; participants should review the rule prior to the call. A question and answer session will follow the presentation.

In addition to the HHS website mentioned above, a wealth of resources are available through the Centers for Medicare and Medicaid Services (CMS) as well as the American Medical Association. In their initial review of the final rule, the AMA said it appeared many of the concerns expressed by physicians had been addressed in the final rule such as in these key areas:

  • Details are provided about the 2017 transition period announced in September.  The only physicians who will experience payment penalties in 2019 are those who choose to report no performance data next year, and those who report for at least 90-days will be eligible for positive payment adjustments.
  • The low-volume threshold that exempts physicians from all performance reporting has been increased from $10,000 in annual Medicare revenue and less than 100 Medicare patients to $30,000 in revenue or 100 patients.  CMS estimates that this change will exempt 32.5 percent of physicians and other clinicians from the program.
  • Performance reporting requirements have been further reduced, and the resource use component of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero for 2017.

Here are some valuable resources available to learn more about this important rule and how it may affect your practice in the coming months and years.

HHS will continue to host listening and learning sessions throughout the country, and welcome additional feedback from patients, caregivers, clinicians, health care professionals, Congress and others on how to better achieve the goals. HHS looks forward to feedback on the final rule with comment period and will accept comments until 60 days after the final rule’s release date or December 14, 2016. Learn how to submit a comment on the final rule electronically here.

Watch the NCMS Bulletin for updates and links to more ready resources as well as upcoming educational programs for our members.


Share this Post


Leave a Reply

Your email address will not be published. Required fields are marked *