On Wednesday the Centers for Medicare and Medicaid Services (CMS) released the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) proposed rule. The document, 962 pages long, includes CMS proposals on how the law creating a new Medicare physician payment system will be implemented beginning in 2017.
MACRA, passed by Congress in April 2015, ends the Sustainable Growth Rate (SGR) formula and its projected over 20% payment reduction and sunsets the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VM) and the Electronic Health Record Incentive Program at the end of 2018.
Beginning in 2019, Medicare payments to physicians will be made based upon a physician’s participation (dependent upon patient population and volume) in one of two broad categories: payments through the Merit-based Incentive Payment System (MIPS) or through an Alternative Payment Model (APM). For MIPS, physicians will be scored by the government on a 0-100 point scale based upon their performance in four categories: Quality, Resource Use, Meaningful Use of Certified Electronic Health Record Technology, and Clinical Practice Improvement Activities. For APMs, the proposed rule describes payment opportunities for physicians who participate in new and innovative payment and care delivery models.
The proposed rule has a 60-day comment period; CMS will accept comments through June 27, 2016.