September 15, 2016
The Centers for Medicare & Medicaid (CMS) recently announced that it will give physicians several options to comply with Medicare payment rules set to go into effect next year; this announcement comes in response to complaints from Congress and organized medicine.
Due to the Medicare Access and CHIP Reauthorization Act (MACRA)—the bill that repealed the sustainable growth rate formula for physician reimbursement under Medicare—beginning next year, physicians would have to choose from one of two paths: participate in an alternative payment model such as an accountable care organization; or join in the Merit-Based Incentive Payment System (MIPS), which requires doctors to submit quality reporting data to Medicare.
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However, acting CMS administrator Andy Slavitt wrote in a blog post: “In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017. During 2017, eligible physicians and other clinicians will have multiple options for participation. Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019.”
Mr Slavitt outlined four options that eligible physicians can choose from:
- Test the Quality Payment Program—physicians can avoid negative payment adjustment by submitting just “some” data to the Quality Payment Program, including data from after January 1, 2017.
- Participate for part of the calendar year—physicians can submit quality information “for a reduced number of days; ie, “your first performance period could begin later than January 1, 2017 and your practice could still quality for a small positive payment adjustment.”
- Participate for the full calendar year—practices ready by January 1, could submit quality information for a full year and thus qualify for a “modest” payment adjustment.
- Participate in an Advanced Alternative Payment Model in 2017—practices choosing not to report quality data could instead join an advanced alternative payment model, such as a Medicare Shared Savings program, in 2017.
Further details on these options will become available when CMS releases its final rule for implementing the Quality Payment Program, sometime before November 1. Mr Slavitt commented, “We appreciate the sincere and constructive participation in the feedback process to date and look forward to advancing step by step in that same spirit.”
Reacting to this announcement, the American Medical Association said it “strongly applauds” Mr Slavitt the other teams for listening to concerns about the originally proposed MACRA timeline. Representative Michael Burgess, MD, an ob/gyn, commented in a statement that the announcement, demonstrating the CMS’s dedication to flexibility during the MACRA implementation, “is proof of the benefits of keeping Congress involved in policy implementation.” —Amanda Del Signore