The U.S. Department of Health and Human Services ("HHS") issued a proposed rule under the Medicare Access and CHIP Reauthorization Act of 2015 ("MACRA") on April 27, 2016. Continuing efforts to incorporate quality measures and value into provider payments, HHS's new proposed rule would streamline the current disparate Medicare quality programs into a framework called the Quality Payment Program, which establishes two payment paths: Merit-based Incentive Payment System ("MIPS") and Advanced Alternative Payment Models ("APMs"). MIPS bases reimbursement on four factors: quality, cost, advancing care information, and clinical practice improvement activities. Notably, the advancing care information proposal will allow practitioners to select measures that reflect how technology best suits their practice and will reduce the number of required measures from 18 to 11. The MIPS program is aimed at supporting simple, connected, less-burdensome technology. CMS would begin measuring performance through this payment program in 2017 and would begin payments through the program in 2019. On the other hand, APMs were developed with an eye toward the promotion of the highest quality and most coordinated care that is patient-centered and practice-driven by giving a heightened role to information technology. APMs must meet three requirements: they must (i) use certified electronic health records, (ii) pay for covered professional services based on comparable quality measures, and (iii) either be an enhanced medical home or bear more than nominal risk for losses. This program is meant to strengthen quality-based payments while incentivizing flexible, coordinated care that is patient-centric. Medicare practitioners who participate to a sufficient extent in the various APMs, such as Comprehensive Primary Care Plus and Next Generation ACOs, may be exempt from MIPS reporting requirements and may qualify for financial bonuses. Comments to the proposed rule are due June 27, 2016.
The content of this article is intended to provide a general guide to the subject matter. Specialist advice should be sought about your specific circumstances.
