Part One: MACRA Overview and MIPS

In its final MACRA rule, CMS significantly revamped the physician pay rule to make it easy for physicians to avoid penalties and to earn bonuses, and the agency is leaving the final rule open for comment to make it easier to revise. Among the changes, physicians need only report on one quality measure in each of two categories next year to avoid penalties, a third of practices are exempted from the program entirely, and there is a new alternative pay model option aimed at making it easier for small practices to qualify for the 5 percent bonus that comes with being counted as an alternative pay model. MACRA: An Overview The Medicare Access and CHIP Reauthorization Act (MACRA) creates two paths for physicians in the Quality Payment Program (QPP). Either physician performance is measured by the Merit-based Incentive Payment System (MIPS) or they earn enough revenue from alternative pay models to receive the 5 percent bonus on Part B revenues. Although the law refers to them as APMs, CMS calls them advanced APMs to distinguish them from what the agency generically calls alternative pay models, many of which do not include penalties and therefore do not qualify for the bonus. Although physicians in APMs are not subject to MIPS, they must participate in quality programs comparable to those in MIPS. “In 2017, we estimate that we will pay approximately $1 billion in bonuses for high quality care to clinicians in both advanced APMs and MIPS,” Acting CMS Administrator Andy Slavi...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs