MACRA Final Rule with Comment Period: What You Need to Know

On October 14th, 2016, the Centers for Medicare and Medicaid Services (CMS) released the Final Rule implementing the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The goal is to improve the quality of healthcare by structuring the different value-based payment models that have replaced the traditional fee-for-service system. This rule finalizes policies to improve physician and other clinician payments.

The Quality Payment Program rewards the delivery of quality patient care through two paths:

1) Advanced Alternative Payment Models (Advanced APMs), providing added incentives to deliver high-quality and cost-efficient healthcare.

2) The Merit based Incentive Payment System (MIPS), a new program for certain Medicare-enrolled practitioners.

Both paths provide payments to clinicians attached to some measure of quality and medical value. Advanced APM provides annual bonuses to clinicians and the opportunity to earn more if they meet savings goals.

MIPS evaluates its participants based on self-reported measures. The majority of clinicians will automatically be enrolled in MIPS unless they choose to participate in APM.

The new flexible opportunities reward clinicians that focus on patient engagement and care coordination and enables them to participate in a form that is best for them, their practice, and their patients.

The provisions of this final rule with comment period are effective on January 1, 2017, establishing special policies for the first year of the
Quality Payment Program, referred to as the “transition year” throughout this final rule with comment period. This transition year corresponds to the first performance period of the program, calendar year (CY) 2017, and the first payment year, CY 2019.

During the transition year, providers will not be evaluated on cost or resource use. After transition, payment adjustments will be based on four categories: quality (replacing the Physician Quality Reporting System), advancing care information (replacing Meaningful Use), clinical improvement activities, and cost. In 2017, CMS will calculate providers’ costs, but will not use the category to determine payment adjustments.

When the program rolls out on January 1, 2017, organizations have to make sure their IT and health information sharing, data analytics, data management, and structures are ready. The success not only of the MIPS program, but also of high-quality cost-efficient healthcare depends on the quality and reliability of reported data. The participation in alternative delivery and payment models creates momentum for healthcare transformation and efficiency, increasing support for small and independent practices.

Comments to the agency must be received no later than 5 p.m., 60 days after the date of filing for public inspection to be assured consideration. You may submit electronic comments on this regulation to . Summaries and other resources can also be found on CMS’s website

The MACRA train is moving. Get on now!


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