In the recent proposed rules for MACRA, CMS offered some clarity for providers who are trying to decide whether to participate under the Merit-Based Incentive Payment System (MIPS) or the Alternative Payment Model (APM) track. In short, it really is not a decision that the provider makes, but rather a determination made by CMS based on the provider’s level of participation – if any – in qualifying APMs (also known as advanced APMs). Continue reading
Last week CMS released its much-anticipated proposed rules for the Medicare Access and CHIP Reauthorization Act (MACRA), which was passed by Congress approximately 1 year ago and introduced substantive changes in the way Medicare will reimburse physician services. Readers of previous ECG blog posts and articles may recall that, like the ACA before it, this legislation grants the HHS Secretary great latitude in fleshing out the details through rulemaking. While these are only proposed rules, and CMS is using this as an opportunity to solicit commentary from the public, they do shed light on what we can expect when the rules are finalized in November. Continue reading
On December 18, 2015, CMS released its draft plan for developing the quality measures that will be used within both the MIPS and APM components of MACRA. The purpose of this draft plan and the mandate for the Secretary of HHS, at least theoretically, is to:
- Address how measures used by private payors and integrated delivery systems could be incorporated into Title XVIII (i.e., Medicare).
- Describe how coordination across organizations developing such measures might occur.
- Take into account how clinical best practices and clinical practice guidelines should be used in the development of quality measures.
With the passage of the Medicare Access and CHIP Reauthorization Act (MACRA) this past April, a couple of things became evident. First, there are some concepts Congress can agree on – like the unpopularity of the sustainable growth rate (SGR). An overwhelming majority in both houses voted for its repeal.
Second, Medicare is moving away from fee-for-service (FFS) reimbursement and toward value-based payments for physician services. Beginning in 2019, providers will have the option of participating in the merit-based incentive payment system (MIPS) – an enhanced version of the current FFS system – or moving into alternative payment models (APMs). Providers who opt for MIPS will see a period of essentially flat reimbursement; those who accept more risk through APMs will have a chance to reap higher rewards.
Regardless of which reimbursement path providers choose, they’ll need to focus on managing the cost of care and demonstrating value to patients and payors. That much is clear. But MACRA will also have implications that are not so obvious. Continue reading
“Two roads diverged in a yellow wood/And sorry I could not travel both.”
No federal legislation will ever be mistaken for poetry. For one thing, poetry uses far fewer acronyms. But like the narrator in the famous Robert Frost poem quoted above, today’s providers find themselves staring at a fork in the road. Continue reading