CMS Releases Quality Payment System Proposed Rule

Printer-friendly versionPrinter-friendly version

This week CMS released its proposed rule to implement the Quality Payment System consisting of the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs).  This system was passed in to law last year as part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) that among other things fixed the Sustainable Growth Rate (SGR) problem that annually had left physicians facing over 20% cuts in Medicare reimbursement.  The law moves the federal payment/reimbursement system away from fee-for-service and toward a system based on payment for quality and value such as patient outcomes across settings of care.  MIPS and the APMs will replace and consolidate all other federal reporting and quality reimbursement initiatives such as PQRS and the Value-Based Payment Modifier.  It also replaces the HIT Meaningful Use initiative by folding HIT adoption in to the Quality Payment System. 

Physicians (both those in independent practice and those employed by others including health systems) will have their finances impacted by these provisions before the end of this decade.  Full implementation will be in place by the middle of the next decade.  These provisions will be what health care quality and payment mean in the United States for years to come as private payers follow these CMS actions within their own payment/reimbursement systems.  All providers of all sizes will be impacted by these initiatives.  Collaboration within provider organizations, across care settings, and throughout communities will be key to achieving success for all.   

Being educated about these provisions and being engaged about this evolution in health care are vital toward the physician profession being valued partners in these gigantic changes no matter what setting a physician practices in and no matter what their line of medical practice is. 

PCMS will be scheduling Practice Success Forum webinars with our Members of Congress to further discuss this and other issues of importance to physicians.  Additional Practice Success Forums will focus on how to achieve success within this new environment, among other topics of current relevance to physicians and PAs. 

Additional information about these transformations will be provided on an ongoing basis. 

Below are links to a few news pieces covering the release of the proposed rule by CMS within the last two days.  Dr. Patrick Conway, Deputy Administrator and Chief Medical Officer for CMS, is quoted by the news media.  He will be speaking with the PCMS membership on a Practice Success Forum webinar on June 17 at 8am.  Also below is a link to the proposed rule.  It is nearly 1,000 pages and near the front are instructions about how individuals may comment on the proposed rule.  Comments are due to the federal government by June 27.

Links to news media pieces this week:

http://www.healthleadersmedia.com/finance/new-medicare-rules-would-increase-bonus-opportunities-ease-reporting?spMailingID=8853116&spUserID=MTMyMzQ1MjQ1NTg1S0&spJobID=902919700&spReportId=OTAyOTE5NzAwS0

http://www.healthcareitnews.com/news/macra-proposed-rule-published-hhs-streamlining-federal-programs-including-meaningful-use

http://www.usatoday.com/story/news/politics/2016/04/27/feds-propose-docking-medicare-doctors-quality-issues/83607072/

Link to CMS proposed rule for Quality Payment System:

https://gallery.mailchimp.com/d5749e957e138f53b343997c1/files/MIPS_APM_Proposed_Rule.pdf