CMS unveils final MACRA implementation rule: 10 changes to the Quality Payment Program

The Centers for Medicare & Medicaid Services on Thursday released a final rule on the Quality Payment Program that the agency said is meant to ease burdensome regulations.

The 1,658-page final rule (PDF) includes a comment period through Jan. 1, 2018, about the second year and future years of the Quality Payment Program, an initiative established under the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) to reward physicians for value and outcomes either through the Merit-based Incentive Payment System and Advanced Alternative Payment Models.

The agency said in an announcement that the final rule includes policies that will provide clinicians with a smoother transition to the Quality Payment Program because it reduces regulatory burdens and support clinicians in small and rural practices so they can successfully participate in the program.

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Among the changes noted in a CMS fact sheet (PDF), the agency is:

  1. Decreasing the number of clinicians required to participate in the program.
  2. Adding an option to help clinicians and small, rural practices join together to share the responsibility of participating in value-based payment.
  3. Adding a new hardship exception to help small practices and clinicians that were impacted by Hurricanes Harvey, Irma and Maria and didn’t have access to electronic health records because of the natural disasters.
  4. Offering more details on how clinicians can receive credit for payment bonuses through advanced alternative payment models.
  5. Raising the performance threshold to 15 points in year 2 (from three points in the transition year).
  6. Allowing the use of 2014 Edition and/or 2015 Certified Electronic Health Record Technology (CEHRT) in year 2, but giving a bonus to those that use only 2015 CEHRT.
  7. Giving up to five bonus points on the final score for treatment of complex patients.
  8. Adding five bonus points to the final scores of small practices.
  9. Providing more options to small practices groups of 15 or fewer clinicians, including an exclusion of individual MIPS eligible clinicians or groups with less than or equal to $90,000 in Part B allowed charges or less than or equal to 200 Part B beneficiaries. It will also provide an opportunity to form or join a virtual group to participate with other practices, and continue to award small practices three points for measures in the Quality performance category that don’t meet data completeness requirements.
  10. Making it easier for practices to participate in Advanced APMs, which may allow them to quality for incentive payments. The changes extend the 8% generally applicable revenue based nominal amount standard that allows APMs to qualify as Advanced APM for two additional years, through performance year 2020; exempts Round 1 Comprehensive Primary Care Plus participants certain currently participating clinicians from the 50 clinician limit on organizations that can earn incentive payments by participating in medical home models; changes the requirement for Medical Home Models so that the minimum required amount of total financial risk increases more slowly; makes it easier for clinicians to qualify for incentive payments by participating in Advanced APMs that begin or end in the middle of a year.

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“During my visits with clinicians across the country, I’ve heard many concerns about the impact burdensome regulations have on their ability to care for patients,” Seema Verma, administrator of CMS, said in the announcement. “These rules move the agency in a new direction and begin to ease that burden by strengthening the patient-doctor relationship, empowering patients to realize the value of their care over volume of tests, and encouraging innovation and competition within the American healthcare system.”