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CMS Proposes New Physician Payment System

Posted in Accountable Care Organizations, Affordable Care Act, Legislation and Public Policy, Medicare and Medicaid, Reimbursement Matters

On April 27, the Centers for Medicare & Medicaid Services (CMS) released a proposed rule that would establish a new physician reimbursement system for Medicare beginning in 2019. The Department of Health and Human Services (HHS) issued a press release about the rule.

The proposed rule, titled “Merit-Based Incentive Payment System (MIPS) and Alternative Payment Models (APMs) in Medicare Fee-for-Service” (CMS-5517-P), is the first step in establishing a new modern system of physician reimbursement since the permanent “doc fix” legislation, the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), was enacted last year (as previously discussed here). 

In HHS’s press release, Secretary Sylvia Burwell said, ““The legislation Congress passed a little over a year ago was a milestone in our efforts to advance a health care system that rewards better care, smarter spending, and healthier people. We have more work to do, but we are committed to implementing this important legislation and creating a health care system that works better for doctors, patients, and taxpayers alike.”

The rule gives Medicare Part B providers (doctors and other clinicians) a choice of participating in either the Quality Payment Program through MIPS, under which they would receive a quality performance score that could lead to reductions or increases in their Medicare reimbursement, or an APM, under which they would be exempted from MIPS reporting requirements and eligible for financial bonuses. APMs include the Comprehensive Primary Care Plus (CPC+) model, the Next Generation ACO model (previously discussed here and here), and other models under which clinicians accept risk and may receive rewards for improving the quality of care while reducing costs. The CPC model, which CMS called “the largest-ever multi-payer initiative to improve primary care in America,” was announced in a press release on April 11.

Regardless of which path a Medicare clinician chooses, the goal of the new system is to adjust reimbursements to reward or penalize providers based on how healthy they keep their patients. The proposed rule also contains provisions pertaining to Medicare’s meaningful use program.

The proposed rule will be published in the Federal Register on May 9, and public comments will be due by June 27.

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