MACRA Released

On Friday, CMS released the MACRA final rules, its innovative payment system for Medicare replacing the sustainable growth rate formula and the EHR Incentive Program for Medicare providers.

MACRA creates the framework for providers to participate in the CMS Quality Payment Program through either the Advanced Alternative Payment Models (Advanced APMS) or the Merit-based Incentive Payment System (MIPS). The goal of these models is to reward value and outcomes, specifically supporting CMS’ goal of paying for quality and value. The MIPS program importantly consolidates components of PQRS, the Physician Value-based Payment Modifier (“VM”), and the EHR Incentive Program (aka meaningful use).

“As prescribed by Congress, MIPS will focus on: quality – both a set of evidence-based, specialty-specific standards as well as practice-based improvement activities; cost; and use of certified electronic health record (EHR) technology (CEHRT) to support interoperability and advanced quality objectives in a single, cohesive program that avoids redundancies. Many features of MIPS are intended to simplify and integrate further during the second and third years.”

Though the new rule becomes effective on January 1st, 2017, clinicians will be given a transition period in which to prepare for MIPS, with negative payment adjustments not occurring until January 1, 2019. MACRA will sunset payment adjustments under the Medicare EHR Incentive Program, PQRS and VM after CY2018. For those clinicians not ready to start on January 1st, 2017 they have until October 2, 2017 to commence participation. Regardless of when a clinician starts he/she needs to submit performance data by March 31, 2018.

CMS’ Quality Payment Program has the following strategic objectives:

(1) to improve beneficiary outcomes and engage patients through patient-centered Advanced APM and MIPS policies;

(2) to enhance clinician experience through flexible and transparent program design and interactions with easy-to-use program tools;

(3) to increase the availability and adoption of robust Advanced APMs;

(4) to promote program understanding and maximize participation through customized communication, education, outreach and support that meet the needs of the diversity of physician practices and patients, especially the unique needs of small practices;

(5) to improve data and information sharing to provide accurate, timely, and actionable feedback to clinicians and other stakeholders; and

(6) to ensure operational excellence in program implementation and ongoing development.

CMS also launched a new website with graphics to aid in understanding the MACRA regulations. The view the interactive website click here.

CMS has also provided a 24-page executive summary. Click here to view the executive summary.

If you have questions about MACRA please contact Elana Zana.