CMS woos clinicians in new Medicare payment model

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The Centers for Medicare and Medicaid Services on Friday released its landmark physician payment rule to replace the controversial sustainable growth rate methodology that Congress deep-sixed last year in the bipartisan Medicare Access and CHIP Reauthorization ACT.

The bill, which reinforced Medicare’s trajectory towards value-based payment and additionally extended funding for the Children’s Health Insurance Program for two years by requiring high-income seniors to cover basic Medigap co-payments, marked a rare bipartisan achievement for the gridlocked congress.

Signed into law by President Barack Obama in April of last year, CMS issued a proposed rule to implement the law earlier this year. But after processing more than 100,000 stakeholder comments, the agency amended its plan last week by softening key program parameters in a concerted effort to stimulate provider participation.

As Dentons’ federal health care practice spotlighted in an advisory Monday, changes from the proposed to final rules include:

[T]he Final Rule gives participating clinicians three paths to choose from within [Merit-Based Incentive Payment System], including options with minimal reporting requirements that would allow clinicians to avoid negative payment adjustments. The rule also states that it anticipates this flexibility will extend into 2018, with additional guidance to be published in 2017.

In order to increase the potential for clinicians to participate in Advanced [Alternative Payment Models], the Final Rule also allows for at least one new potential Advanced APM option, Medicare Shared Savings Program (MSSP) ACO Track 1+. It outlines the new Track 1+ option that is available to existing and new MSSP ACOs alike. This option will allow additional MSSP ACO models to participate in the [Quality Payment Program] as an Advanced APM. In addition, it simplifies the “all-or-nothing” requirements for the use of certified electronic health record technology (CEHRT), establishes standards for the Medical Home Model and provides additional flexibility for small and independent practices.

The takeaway:

CMS believes … the Final Rule will allow them to continue to develop policies that can both be practically implemented within the capacities and capabilities of the current system while cotinuing the drive towards patient-centered and quality-driven health care.

To come up to speed on the various incentives for clinician participation in Advanced APMs or the new quality-based payment framework in MIPS, read the entire advisory here and contact our resident MACRA authorities in Washington, Bruce Merlin Fried and Jenifer Healy.