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quality payment program

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On November 4, 2016, the Centers for Medicare and Medicaid Services (CMS) published the final rule with comment period for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) as the payment program that will replace the Sustainable Growth Rate methodology. The rule finalizes MACRA’s Quality Payment Program, whose primary goal is to reduce administrative burden on physicians to allow them to focus on improving care, promote the adoption of value-based care, and smooth the transition to these new models of care. The final rule establishes guidelines for Medicare health care providers to participate in either the Advanced Alternative Payment Models (APMs) or the Merit-based Incentive Payment System (MIPS), which consolidates components of three existing programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals. According to CMS, the Advanced APMs pathway provides clinicians with the opportunity to be paid more for better care and investments that support patients by reducing existing requirements, while still emphasizing and rewarding quality care. Participants in the advanced APMs must meet the following requirements:

  • Be part of CMS Innovation Center models, Shared Savings Program tracks, or certain federal demonstration programs;
  • Use certified EHR technology;
  • Base payments for services on quality measures comparable to those in MIPS; and
  • Be a medical home model expanded under innovation center authority or require participants to bear more than nominal financial risk for losses.

The final rule has a 60-day comment period, with comments due by Monday, December 19, 2016. RCPA will be offering a webinar in the near future on the details of the final rule, hosted by the American Medical Rehabilitation Providers Association (AMRPA). The date and time will be released soon.

The Centers for Medicare and Medicaid Services (CMS) published a proposed rule in the August 2, 2016 Federal Register that proposes to implement three new Medicare Parts A and B episode payment models under section 1115A of the Social Security Act, which are meant to improve quality and lower cost. The proposed rule includes a new mandatory bundled payment model for cardiac care in 98 geographical markets for patients who have a heart attack or undergo bypass surgery. The rule would also extend the existing bundled payment model for hip and knee replacements – the Comprehensive Care for Joint Replacement model – to include hip and femur surgeries. Also proposed are new incentive payments designed to increase the use of cardiac rehabilitation. Additionally, new pathways are outlined for physicians participating in bundled payment models to qualify for payment incentives under the proposed Quality Payment Program, which implements the Medicare Access and CHIP Reauthorization Act (MACRA). CMS issued a fact sheet to provide more detailed information on the key provisions of this proposed rule. Comments are due by October 3, 2016.