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CMS Releases MACRA Quality Payment Program Final Rule

An Oct. 14 final rule gives providers some flexibility in how they transition to Medicare’s new Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA), the 2015 law that repealed the sustainable growth rate.

MACRA consolidated three existing physician quality programs into the QPP:

  • the physician quality reporting system;
  • the Medicare Electronic Health Records Incentive Program for eligible professionals; and
  • the value-based payment modifier.

The final rule, issued with a comment period by the Centers for Medicare & Medicaid Services, includes provisions related to two QPP payment tracks:  the default merit-based incentive payment system (MIPS) and advanced alternative payment models (APMs).

Details of Final Rule

The final rule establishes a “transition year” for the first performance year, calendar year (CY) 2017, and first payment year, CY 2019, as well as flexibility for providers to choose their participation pace. To avoid receiving negative payment adjustment in CY 2019, eligible clinicians have four options: three that involve submitting data to MIPS and one that involves joining an advanced APM.

The rule states that physicians are eligible to earn a lump sum of 5 percent of payments for professional services applied to payment years 2019 through 2024. Physicians also are exempt from MIPS reporting requirements if they participate in advanced APMs.

The final rule also offers potential new pathways for participating in the advanced APM track, including a new accountable care organization Track 1+ model and the Comprehensive Care for Joint Replacement model.

Along with the final rule, CMS unveiled a website for physicians that explains the QPP and will provide updated information about future training opportunities and educational outreach. CMS is encouraging feedback on all aspects of the rule during a 60-day public comment period.

America’s Essential Hospitals published a detailed Action Update for members Oct. 19 on the MACRA final rule and QPP. Contact Director of Policy Erin O’Malley at eomalley@essentialhospitals.org or 202.585.0127 with questions.

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About the Author

Maryellen Guinan is a senior policy analyst at America's Essential Hospitals.