Medicare finalizes sweeping changes to physician payments

Originally published in the October 14, 2016 issue of MGMA’s Washington Connection
Reprinted with permission from MGMA

Today, the Centers for Medicare & Medicaid Services (CMS) released the highly-anticipated final rule implementing the Medicare physician payment reforms enacted as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). With the passage of MACRA, Congress set Medicare on a path away from automatic, annual updates hampered by the threat of payment cuts under the flawed sustainable growth rate formula toward a system that focuses more on clinical quality and cost effectiveness. In response to MGMA’s extensive advocacy efforts, the final rule includes greater flexibility for group practices in the Merit-Based Incentive Payment System (MIPS) and more alternative payment model (APM) opportunities.

Key provisions of the final rule:

  • Establishes 2017 as the first performance measurement year for the new Merit-Based Incentive Payment System (MIPS);
  • Reduces the quality reporting burden during first year of MIPS by allowing practices to submit one quality measure or one improvement activity to avoid a penalty or submit data for a reduced reporting period of 90 days to potentially earn a positive payment adjustment; and
  • Details criteria for qualification as an APM participant, including eligibility for bonus payments.

MGMA Government Affairs staff are closely reviewing the final rule and will provide detailed resources to members in the coming weeks. A link to the final rule and additional information is posted on MGMA’s MACRA Resource Center. Members can also learn more by attending the “Under the MACRAscope” series at MGMA’s 2016 Annual Conference in San Francisco. Register today!