The Centers for Medicare and Medicaid Services (CMS) wants to replace the meaningful use program for physicians with a program that is “simpler, less burdensome, and more flexible,” according to an article posted on the HealthLeaders Media website.
Under proposed rules released by the CMS, the meaningful use incentive payment and penalty program created by the 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act would be replaced by the Advancing Care Information program for physicians who are paid by Medicare. The new rules are based on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed by Congress last fall.
Medicare currently measures the value and quality of care provided by doctors and other clinicians through a patchwork of programs, according to the HealthLeaders article. Some clinicians are part of alternative payment models, such as accountable care organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program, and most participate in programs such as the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record (EHR) Incentive Program.
Congress’ objective in enacting MACRA was to streamline these various programs into a single framework to help clinicians transition from payments based on volume to payments based on value. The new proposed rule would implement these changes through a unified framework called the Quality Payment Program, which consists of two paths: the Merit-Based Incentive Payment System (MIPS) and advanced alternative payment models (APMs).
The 2015 MACRA Act repealed the Medicare sustainable growth rate (SGR) methodology for updates to the physician fee schedule and replaced it with MIPS. Under the proposed CMS rule, MIPS would consolidate components of three existing programs––the Physician Quality Reporting System (PQRS), the Physician Value-Based Payment Modifier, and the Medicare EHR Incentive Program––but would continue to focus on quality, resource use, and the use of certified EHR technology. The EHR Incentive Program would be folded into MIPS, starting on January 1, 2017.
In addition, the proposed rule advocates the use of advanced APMs. These payment models must meet three requirements: 1) require participants to use certified EHR technology; 2) provide payment for covered professional services based on quality measures comparable with those used in the quality performance category of MIPS; and 3) be either a medical home model expanded under the MACRA Act or bear more than a nominal amount of risk for monetary losses.
Under the MACRA’s requirements, MIPS would distribute payment adjustments to between approximately 687,000 and 746,000 eligible clinicians in 2019. The CMS estimates that MIPS payment adjustments would be approximately equally distributed between negative adjustments ($833 million) and positive adjustments ($833 million) to MIPS-eligible clinicians, to ensure budget neutrality. In addition, MIPS would distribute approximately $500 million in exceptional performance payments to MIPS-eligible clinicians whose performance exceeds a specified threshold.
The CMS also estimates that between approximately 30,658 and 90,000 eligible clinicians would become “qualifying APM professionals” through participation in advanced APMs, and would receive between $146 million and $429 million in APM incentive payments for 2019.
“It is hard to overstate the significance of these proposed regulations for patients and physicians,” American Medical Association President Stephen J. Stack, MD, said in a statement. “When Congress overwhelmingly passed MACRA last year, lawmakers signaled that they wanted to transform Medicare by promoting flexibility and innovation in the delivery of care, changes that could lead to improved quality and better outcomes for patients.
“Our initial review suggests that CMS has been listening to physicians’ concerns. In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens. The existing Medicare pay-for-performance programs are burdensome, meaningless, and punitive. The new incentive system needs to be relevant to the real-world practice of medicine and establish meaningful links between payments and the quality of patient care, while reducing red tape.”