On October 14, the Centers for Medicare and Medicaid Services (CMS) issued its final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA replaces Medicare’s current payment system for physicians, which pays doctors based on volume, with a Quality Payment Program (QPP) that will pay doctors based on value – in other words, patient outcomes.
The QPP applies to physicians, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists who provide care for more than 100 Medicare patients a year and bill Medicare more than $30,000 a year.
The QPP offers two new payment systems. The “core” system is the Merit-based Incentive Payment System (MIPS), which allows physicians to earn higher payments from Medicare based on their performance. The other is the Advanced Alternative Payment Models (APMs), which rewards physicians for adopting innovative payment models that involve taking on some risk related to their patients’ outcomes.
In 2017, practitioners will need to start recording their performance data. The first payments adjustments, based on the 2017 data, will be made in 2019. If practitioners decline to submit any performance data, they’ll receive a negative 4% adjustment to their 2019 Medicare payments.
If you’re feeling ambitious, you can read the entire rule (more than 2,000 pages long) here. Or you can visit the far more approachable CMS website here for more information. The final rule is open for comment for 60 days and will go into effect January 1, 2017.