On October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) released the final rule with detailed regulations to implement the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015. This law repealed the flawed Medicare Sustainable Growth Rate (SGR) formula that had served as the underpinning of Medicare physician payment for many years. MACRA replaced the SGR with the Quality Payment Program (QPP).
The QPP program has two pathways for compliance. 1) Merit-Based Incentive Payment System (MIPS) or 2) Alternative Payment Model (APM). Physicians and other eligible providers must choose to participate in one of these programs to avoid a Medicare payment penalty in 2019.
Under MIPS, providers may choose to start reporting between January 1, 2017 and October 2, 2017, depending on the level of readiness. For example, providers may report just one quality measure, 90 days of data, or a year of data. It is up to the provider. All reporting of performance data must be complete by March 31, 2018. Of note, CMS announced the availability of $20 million per year for five years to help educate small practices about MACRA participation.
If a provider is part of an Advanced Payment Model, there is an opportunity to earn a five percent bonus payment in 2019. Importantly, CMS is looking to broaden APMs to include participation by medical specialists.
We encourage all members to visit the new CMS QPP website.
On this site you will find an Executive Summary and CMS Fact Sheet on the final rule.
SCMR will continue to review the rule and provide updates to members as new educational materials become available.
In addition, we urge you to view the resources available through the American Medical Association.
For More Information
To learn more about the final rule and the Quality Payment Program, view the following resources:
- Quality Payment Program website
- Press release
- Executive summary, fact sheet and other resources
- CMS Blog post by Acting Administrator Andy Slavitt
Submit a Formal Comment
CMS encourages the public to submit comments on the MACRA final rule. Comments are due 60 days after the date of filing for public inspection, and can be submitted in several ways, including:
- Electronically via https://www.regulations.gov
- By regular mail
- By express or overnight mail
- By hand or courier
