CMS publishes final MACRA rule

Editor's Note

The Centers for Medicare & Medicaid Services (CMS) on October 14 issued a final rule with comment period for implementing provisions of the new physician payment system required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), according to the October 14 Modern Healthcare.

The rule replaces the sustainable growth-rate formula for physician pay with a Quality Payment Program that shifts physicians from fee-for-service to a quality and value-based payment program.

To avoid penalties in the Quality Payment Program, physicians will participate in one of two reimbursement tracks:

• The default Merit-based Incentive Payment System (MIPS). In MIPS, physician pay is based on success in four categories−quality, resource use, clinical practice improvement, and advancing care information (based on meaningful use of electronic health records). Physicians can earn plus or minus 4% of reimbursement in 2019, with the adjustment potential growing to 9% in 2022.
• Advanced Alternative Payment Models (Advanced APMs). Physicians can opt out of MIPS if they participate in an alternative payment model, such as an accountable care organization or patient-centered medical home. Physicians can earn annual bonuses of 5%, and they will be exempt from MIPS reporting measures.

Comments will be received on the rule for 60 days.

Nearly a third of physicians could be exempt from Medicare's new Merit-based Incentive Payment System under a final rule the CMS issued Friday for implementing the Medicare Access and CHIP Reauthorization Act. The CMS also signaled it would broaden the opportunities for physicians to participate in alternative models that make them eligible for bigger rate increases and bonuses.