Long-awaited rule for Quality Payment Program unveiled


The U.S. Department of Health and Human Services recently issued its long-awaited final rule on the Quality Payment Program (QPP) under the Medicare Access and CHIP Reauthorization Act (MACRA).

The new rule is designed to move the healthcare industry away from a volume-based system to value-based care models. (Read: see fewer patients, provide better quality care). It will, “equip clinicians with the tools and flexibility to provide high-quality, patient-centered care,†stated HHS.

The new program, which put an end to the Sustainable Growth Rate formula, envisions clinicians working together to have a full understanding of patients’ needs. Medicare will pay for what works, thus spending taxpayer money more wisely and providing better care for patients.

The Quality Payment Program provides two paths from which providers can choose:

  •     Advanced Alternative Payment Models (APMs) or
  •     The Merit-based Incentive Payment System (MIPS)

Those who participate in an Advanced APM, through Medicare Part B, can earn an incentive payment for participating in an innovative payment model. Providers who obtain better health results and reduce costs for the care of their patients will receive a portion of the savings. CMS estimates that as many as 120,000 healthcare providers will be eligible for Advanced APMs in the first year.

Those who choose to participate in traditional Medicare Part B will participate in MIPS where they can earn a performance-based payment adjustment. Those who participate in MIPs will see a positive, neutral, or negative payment adjustment of up to 4 percent. However, that may vary depending on how much performance data the clinician submits and the quality of the results. This adjustment percentage could grow to as much as 9 percent in 2022. CMS estimates approximately 500,000 providers will be eligible for participation in MIPS in the first year.

Physicians, physician assistants, nurse practitioners, clinical nurse specialists and certified registered nurse anesthetists who bill Medicare more than $30,000 a year and who provide care for more than 100 Medicare patients a year can participate in the new QPP.

The first performance period opens Jan. 1, 2017 and closes Dec. 31, 2017. Providers can participate on a flexible performance period. Those who are ready to take part can begin immediately, while others who are less prepared can do so later in the coming year.

“A critical feature of the program will be implementing these changes at a pace and with options that clinicians choose. Today’s policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures, stated Andy Slavitt, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS).

HHS says the new rule grew out of a months-long listening tour with nearly 100,000 attendees and nearly 4,000 public comments.

“A common theme in the input HHS received was the need for flexibility, simplicity, and support for small practices,†HHS stated.

The new rule represents a paradigm shift in quality reporting and payment options. There are many things providers should consider before deciding which option is best for them. The Health Law Offices of Anthony C. Vitale can assist you in understanding these changes and what they might mean to your practice. Give us a call at 305-358-4500.

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