Back in April, CMS issued a Notice of Proposed Rulemaking to put the components of the Medicare Access and CHIP Reauthorization Act of 2015 into place. This bipartisan legislation is now a reality and will replace the flawed Sustainable Growth Rate formula.

So what needs to happen in order to sunset our old system and make way for the new sunrise, otherwise known as the Quality Payment Program? To take this plan to the next level, Department of Health and Human Services Secretary, Sylvia Burwell, has issued a timeline for two specific reform goals that will deliver this new “system that spends health care dollars more wisely … a system that makes our communities healthier.”


Photo Courtesy of CMS

The goals are as follows:

    1. Thirty percent of all Medicare provider payments will be in Alternative Payment Models (APMs) that are tied to how well providers care for their patients (rather than how many services they provide) by the end of 2016. This goal has already been met. By the end of 2018, 50% of payments should be tied to participation in an APM. According to CMS, the physician community is well on track to meeting that goal, as well.
    2. The second goal ties directly into the Merit-based Incentive payment System (MIPS), stating that 85% of fee-for-service payments should be tied to quality and value by the end of 2016; 90% by 2018.

The Quality Payment Program will be comprised of these two tracks, or payment models (APMs and MIPS). Ultimately, the broader goal is not only to encourage more immediate coordination and all-around care, but also to encourage more clinicians to participate in APMs. The understanding is that most clinicians will not be able to make that transition right away. There is no official end date to MIPS at this point, however.

MIPS will fold PQRS, Meaningful Use and the Physician Value Modifier under one roof, and “theoretically” reduce some of the reporting burdens physicians now undergo. PQRS, Meaningful use and the Physician Value Modifier will end with the conclusion of 2016 and MIPS will begin in 2017.

Next we will break down all of the components of both MIPS and APMs, as we continue to make this exhaustive new rule, in all of its 900 or so pages, easier for you to digest in the midst of your busy lives.

The comment period is almost over, ending on June 27.

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