CMS Released Final Rule Implementing MACRA

CMS Finalizes New Medicare Physician Payment System with Additional Flexibilities Physicians Allowed to “Pick their Pace” in 2017

This morning, the Centers for Medicare and Medicaid Services (CMS) released the much-anticipated final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA).
The Final Rule sets forth the guidelines for clinician participation in Medicare's new Quality Payment Program (QPP), which includes one of two pathways: the Merit-Based Payment Incentive Program (MIPS) or Advanced Alternative Payment Models (APMs). Clinicians will need to participate in one of the two pathways in 2017 to avoid a negative payment adjustment in 2019. 

CMS heard the concerns of stakeholders during the MACRA comment period, and included additional flexibilities in the initial years of the QPP with the primary goal of encouraging participation. “Today's policies are designed to get all eligible clinicians to participate in the program, so they are set up for successful care delivery as the program matures,” said CMS Acting Administrator Andy Slavitt.

Pick Your Pace of Participation

As CMS revealed in September, the final rule allows clinicians to “pick their pace” during the 2017 performance year to avoid a payment penalty. 

Clinicians will be exempt from a payment penalty in 2019 if they choose any one of the following four options:
  1. Clinicians can choose to report to MIPS for a full 90-day period or, ideally, the full year,and maximize the MIPS eligible clinician's chances to qualify for a positive adjustment. MIPS eligible clinicians who are exceptional performers, as shown by the practice information they submit, are eligible for an additional positive adjustment for each year of the first 6 years of the program. 
  2. Clinicians can choose to report to MIPS for a period of time less than the full year performance period 2017 but for a full 90-day period at a minimum and report more than one quality measure, more than one improvement activity, or more than the required measures in the advancing care information performance category in order to avoid a negative MIPS payment adjustment and to possibly receive a positive MIPS payment adjustment. 
  3. The simplest way for clinicians to avoid a negative payment adjustment in 2019 is if they report any information.  This could include one measure in the quality performance     category; one activity in the improvement activities performance category; or all the required measures of the advancing care information performance category. If a MIPS eligible clinician chooses to not report even one measure or activity, they will receive the full negative 4 percent adjustment in 2019. 
  4. MIPS eligible clinicians can participate in Advanced APMs, and if they receive a sufficient portion of their Medicare payments or see a sufficient portion of their Medicare patients through the Advanced APM they will qualify for a 5 percent bonus incentive payment in 2019. 

Clinicians can start collecting performance data on January 1, 2017.  However, the 90-day reporting period can occur anytime between January 1 and October 2, 2017.  All performance data must be submitted to CMS by March 31, 2018.  Clinicians can improve their chances of getting an additional positive payment adjustment by reporting more data from which performance will be assessed.

Medicare-enrolled clinicians who will be excluded from MIPS, include newly Medicare-enrolled MIPS eligible clinicians, Advanced APM Qualified Participants (QPs), certain partial QPs, and clinicians that fall under the low-volume threshold, which has been finalized as clinicians who have less than or equal to $30,000 in Medicare Part B allowed charges or less than or equal to 100 Medicare patients. MACRA does not affect facility payments. 

Other Highlights from the Final Rule

  • For the initial MIPS year, the Resource Category will not be scored, although resource use information will still be collected from administrative claims data. The new performance categories for 2019 scoring will be weighted as follows:
  • Quality = 60%
  • Resource Use = 0%
  • Clinical Practice Improvement Activities = 15%
  • Advancing Care Information = 25%
  • Under the Quality Category, CMS did not finalize a cross-cutting measure reporting requirement. Instead, for full credit under the Quality Category, clinicians must report 6 measures, including one outcome measure. If an outcome measure does not exist for a specialty, the clinician may report on one high-priority measure. 
  • CMS reduced the quality measure reporting threshold to 50% of the MIPS eligible clinician or group's patients that meet the measure's denominator criteria, regardless of payer for the performance period. the 50% threshold applies to all reporting mechanisms. CMS had proposed a 80% threshold for claims and 90% for all other reporting mechanisms, including Qualified Clinical Data Registries.
  • CMS has modified its definition of a non-patient facing MIPS eligible clinician as an individual who bills 100 or fewer patient-facing encounters (including Medicare telehealth services) during the determination period, and a group provided that more than 75 percent of the NPIs billing under the group's TIN meet the definition of a non-patient facing individual MIPS eligible clinician during the non-patient facing determination period. 
ASNC has taken every opportunity to respond to CMS' requests for public comment on the design of the new payment system. ASNC will undertake a thorough review and analysis of the final regulations and provide guidance to ASNC members for complying with the new payment system. Visit ASNC MACRA Resource Center