Mutual Matters

CMS MACRA New Framework for Paying Physicians

Posted by Jennifer on May 13, 2016 2:30:00 PM

In May, 2016, the Centers for Medicare and Medicaid Services (CMS) released key provisions for implementing the bipartisan Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).

Call to action:  HHS is accepting provider comments and feedback on MACRA until June 26, 2016, through their website: http://www.cms.gov/Regulations-and-Guidance/Regulations-and-Policies/eRulemaking/index.html?redirect=/eRulemaking

CMS announcshutterstock_121836910.jpged at the beginning of 2016 that both MU and PQRS have now been consolidated under MACRA creating two Quality Payment Programs for paying physicians.

MACRA

  • ends the Sustainable Growth Rate (SGR) for determining Medicare payments to providers
  • creates a new framework for paying providers for quality while moving toward more value-based payments

MIPS (Merit Based Incentive Payment System)

  • consolidates PQRS, the Value-Based Payment Modifier and Medicare Electronic Health Record (EHR) incentive program
  • continues to be linked to both value and quality with physician pay
  • expects physicians and hospitals to demonstrate they have moved beyond basic MU –to building care models that improve clinical outcomes

For example, as part of the performance category under MIPS, a program called Advancing Care Information (ACI), allows physicians the flexibility to choose the measures and activities that are appropriate to the type of care they provide. Providers will be reimbursed accordingly based on their success. The measures include cost, quality, security, interoperability and clinical practice improvement activities.

APM (Alternative Payment Models)

  • A step beyond MIPS and participates in APMs or Advanced APMs
  • Examples of APMS include Accountable Care Organizations (ACOs), Patient Centered Medical Homes (PCMHs) and bundled payment models
  • Examples of Advanced APMS include next generation ACO models and the Medicare Shared Savings Program (Tracks 2 and 3)
  • the APM incentive payment will be available from 2019-2024

As new payment models qualify as Advanced APMs, CMS will update its list annually, but will require all clinicians to report through MIPS in their first year.

In April, 2016, HHS issued a fact sheet to implement key provisions of the MACRA. CMS will begin measuring performance for MIPS in January 2017, with incentive payments for both MIPS and APM participation beginning in 2019.

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As one of the leading mutual providers of Medical Professional Liability insurance, we're here to help all healthcare professionals with the challenges they face on a daily basis. The topics we cover include: 

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