MACRA and Medicare Payment Reform: CMS Plans Increased Flexibility on Provider Participation
On Thursday, CMS announced that it intends to allow providers to “pick their pace of participation” for the first compliance year of Medicare’s new payment reform model emphasizing quality patient care. The start of the first compliance year is January 1, 2017.
Thursday’s announcement lays out four options that allow providers more flexibility to comply with MACRA’s new payment schemes through the Merit-based Incentive Payment System (MIPS) or an alternative payment model (APM).
As reported on in an earlier post, provider payments under MIPS will be based on an assortment of measures, organized into four categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology. A MIPS composite performance score will be used to determine if provider payments are adjusted, either upwards or downwards. Alternatively, providers can participate in APMs which involve increased provider reimbursement risk.
In the first option proposed by CMS, providers can report some data to avoid a negative payment adjustment, but will not result in an upward payment adjustment. CMS believes this option will allow providers to prepare for broader participation in 2018 and 2019. In the second option, providers can participate for part of the calendar year, and potentially qualify for a small upward payment adjustment. In the third option, providers can participate for the full calendar year, and potentially for a larger upward payment adjustment. Lastly, in the fourth option, providers can participate in an advanced alternative payment model, such as a Medicare Shared Savings Program Track 2 or 3 or the Comprehensive Primary Care Plus (CPC+) program (if available).
CMS will release additional detail on these four options and other components of Medicare’s new payment reform model under MACRA in its final rule, which it expects to publish by November 1, 2016.