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CMS Releases Final Rule for MACRA

October 17, 2016

On October 14, 2016, the U.S. Centers for Medicare and Medicaid Services (CMS) released its final rule for the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA ends the Sustainable Growth Rate formula for updates to the physician fee schedule, which threatened clinicians participating in Medicare with potential payment cliffs for 13 years. It replaces it with the Quality Payment Program, which rewards the delivery of high-quality patient care.

For physicians and other healthcare providers who participate in Medicare Part B, the Quality Payment Program provides new tools and resources to help give patients the best possible care. Healthcare providers can choose how they want to participate based on their practice size, specialty, location, or patient population.

The Quality Payment Program has two tracks:

  • Advanced Alternative Payment Models (APMs)
  • The Merit-based Incentive Payment System (MIPS)

Healthcare professionals participating in an Advanced APM through Medicare Part B may earn an incentive payment for participating in an innovative payment model. Providers will be able to deliver coordinated, quality care through a streamlined payment system.

Those in traditional Medicare Part B will participate in MIPS, where they earn a performance-based payment adjustment. MIPS will cover four main areas: quality, clinical practice improvement activities, meaningful use of electronic health records, and resource use.

The Quality Payment Program offers phased-in participation. If ready, providers can begin January 1, 2017, and start collecting their performance data. If not ready on January 1, they can choose to start anytime up to October 2, 2017. Performance data must be sent in by March 31, 2018.

2017-2018 will be transition years, giving providers a chance to provide feedback. The first payment adjustments based on performance go into effect on January 1, 2019.

Both SNMMI and the American College of Radiology made comments to the proposed rule and will be reviewing this final rule, which does have some changes from the earlier version, including more support for small practices.

MACRA Final Rule

MACRA Quality Payment Program