The 2,398-page MACRA implementation rule has landed
- CMS on Friday released the highly anticipated final rule that will implement the Medicare Access & CHIP Reauthorization Act of 2015.
- The agency stated it recognizes challenges clinicians face for the law's implementation and decided to finalize transitional policies throughout the final rule.
- "We are finalizing the 2017 performance period for the 2019 Merit-Based Incentive Payment System (MIPS) payment year to be a transition year as part of the development period in the program," the agency noted. "For this transition year, for MIPS, the performance threshold will be lowered to a threshold of 3 points. Clinicians who achieve a final score of 70 or higher will be eligible for the exceptional performance adjustment, funded from a pool of $500 million."
CMS stated it made significant changes in this final rule, including:
- Bolstering support for small and independent practices;
- Strengthening the movement towards Advanced Alternative Payment Models by offering potential new opportunities such as the Medicare ACO Track 1+;
- Securing a strong start to the program with a flexible, pick-your-own-pace approach to the initial years of the program; and
- Connecting the statutory domains into one unified program that supports clinician-driven quality improvement.
In a call to reporters, Dr. Patrick Conway, deputy administrator for innovation & quality, CMS CMO, stated the agency expects 25% of physicians to participate in advanced APMs in 2018.
As far as federal rulemaking processes go, the months between the proposed rule and the release today has been far from quiet regarding the MACRA's proposed implementation. MACRA will eliminate the sustainable growth formula and replace it with a .5% annual rate increase through 2019, after which physicians are encouraged to shift to one of two Quality Payment Programs: 1) Merit-Based Incentive Payment System (MIPS) or 2): Alternative Payment Model (APM).
Released in April, the proposal sought to streamline reporting requirements by combining the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBM), and Meaningful Use (MU) into MIPS.
However, critics contested the timeline where 2017 will serve as the performance year for the 2019 payment year, a relatively mere eight months away for a highly technical program. In addition, some believed the proposed rule would disadvantage smaller practices. "To me, that is the policy concern that we should all be really worried about because consolidation in the healthcare marketplace is the single biggest threat to this movement from volume to value," Dr. Farzad Mostashari, CEO and founder of Aledade, told Healthcare Dive earlier this year.
Before the rule of released, CMS made new options available to help providers ease into the new payment requirements of the MACRA.
CMS handily released an executive summary of the rule which can be found here.
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