CMS this morning dropped the shoe that doctors have been waiting for, releasing a final rule that will implement a new Medicare physician payment system for more than 600,000 clinicians across the country.
The final rule—all 2,398 pages—includes a 60-day comment period to allow for further feedback and implements the new Quality Payment Program that is part of the Medicare Access and Chip Reauthorization Act of 2015 (MACRA). The new payment system replaces the current Sustainable Growth Rate formula.
The government expects to pay physicians and other providers $1 billion in bonuses in 2019, its first payment year, said Andrew Slavitt, CMS’ acting administrator in a press conference to announce release of the final rule. MACRA’s goal is to pay physicians based on the quality of care they provide rather than the quantity of patients they see.
Despite pleas from some physician groups to delay implementation of MACRA, the new rule takes effect on January 1, 2017. However, CMS made changes based on the 4,000 comments it received on its proposed rule released in April and from discussions with doctors around the country, Slavitt said. Their major message was to make the transition as simple and flexible as possible, said Slavitt, who posted a letter to clinicians describing the changes on the CMS blog.
The final rule addresses concerns about small, independent and rural practices and builds in ‘pick your pace’ options that will allow physician practices flexibility in moving to the new system, he said. The final rule includes a low volume threshold exemption and reduced reporting requirements.
Under the Merit-based Incentive Payment System (MIPS)—a traditional Medicare program that most physicians will opt for—only practices that do not participate at all and do not send in any 2017 performance data will see their revenues drop with a negative 4 percent adjustment. All others will see payments remain steady or see an increase.
“We think the vast majority of small practices can succeed,” said Patrick Conway, M.D., CMS’ acting principal deputy administrator.
The final rule will also create more options under the second track of the program, the Advanced Alternative Payment Models (APMs), where practices can earn up to a 5 percent Medicare incentive payment. By 2018, CMS expects 25 percent of physicians will participate in APMs, Slavitt said.
While physician groups will be reviewing the final rule and all its details, initial reaction was mostly positive. CMS listened to physicians concerns and responded by taking concrete steps to help them adjust to the new payment framework, said Andrew W. Gurman, president of the American Medical Association, in an announcement. While pleased to see the significant reporting burden reduction in the first year of the program, Medical Group Management Association president and CEO Halee Fischer-Wright, M.D., said the group was disappointed the flexibility for quality reporting in 2017 “largely disappears in 2018 and beyond.”