News: CMS finalizes new Medicare quality payment program

On October 14, the Department of Health and Human Services (HHS) finalized its policy implementing the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to an announcement made by CMS.

The new program, collectively referred to as the Quality Payment Program (QPP),:

• ends the Sustainable Growth Rate formula for determining Medicare payments for providers’ services
• establishes new framework for rewarding providers for quality care
• combines existing quality reporting programs into one system

The program, set to begin January 1, 2017, requires more than 600,000 clinicians across the country to either participate in an APM, such as an accountable care organization, or join MIPS and regularly submit quality-reporting data to Medicare.

CMS released its proposed rule in the spring, receiving nearly 4,000 comments—including opposition from the American Hospital Association—with the general concern being that physicians wouldn’t have enough time to effectively prepare. During a July 13 hearing, Andrew Slavitt, CMS acting administrator, eluded that the agency would be open to delaying or staggering MACRA rollout and, in September, CMS announced a “pick your pace” option that allows providers to choose how they will participate in the first QPP performance period.

“Overall, we are deeply appreciative to everyone, from Congress to practicing physicians, patient advocates, people with Medicare and their families, and technology companies, who provided input into the launch of the program,” said Slavitt, in a letter on the CMS Blog. “We listened and made changes based on your input.”

CMS offers physician practices resources and support once they select their reporting plan. Accompanying the announcement is a new QPP website, which explains the program and helps clinicians identify the measures most meaningful to their practice or specialty. CMS also announced a new initiative to increase clinician engagement, including a regulatory review to begin reducing unnecessary documentation.