September 14, 2016

What’s in a Name? MACRA: Now is the Quality Payment Program

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Last week the Centers for Medicare & Medicaid Services (CMS) indicated that when the final rule is issued for the Merit based Incentive Payment System (MIPS), it will be different than the proposed rule issued this Spring.  

I know most of you know that MIPS, is part of Medicare Access and CHIP Reauthorization Act (MACRA). But when your acronym has acronyms simple concepts become unnecessarily complex. The fact that Medicare is now calling this the Quality Payment Program adds to the linguistic confusion.    

In any event, CMS has been getting an earful from physicians worried about how they are going to take a final rule published right around Nov. 1 and have things ready to go by Jan. 1, 2017. 

There has been talk that Congress might intervene to delay the implementation date.  In an attempt to calm the waters, last Thursday CMS said they plan to give a variety of options for physicians to participate in the program so they don’t take a reimbursement hit.  Remember that based on what physician groups do in 2017, they can face a 4 percent increase or decrease in their Medicare payments, with the potential upside higher than 4 percent because the payment shifts must be budget neutral. 

Remember that in year one, this program only affects physicians, dentists, physician assistants, nurse practitioners, clinical nurse specialists, and certified registered nurse anesthetists.  Other specialties aren’t included until year three, and hospitals and other institutions aren’t part of the program. 

The announcement last week isn’t a rule, or anything formal.  In fact, finding it is difficult. In it, CMS says that the final rule will have four broad options. 

Your First Option is to Test the Quality Payment Program.

This sounds like the bare bones approach.  As long as you submit some data from after Jan. 1, 2017, you avoid the negative payment adjustment. CMS explains this is designed to ensure that your system is working and that you are prepared for broader participation in 2018 and 2019.  The notice has little detail, but presumably you won’t be eligible for any bonus, you just avoid the decrease.    The second option is to Participate for part of the calendar year. 

The notice doesn’t explain if there are limits on when you start, but it indicates you could still qualify for a small positive payment adjustment. “Small” is not defined.  But by submitting information for part of the calendar year about quality measures, technology use and how you are improving quality, you could get something.  

The third option is to go all in, submitting information for the entire year on quality measures, technology use and improvement activities.  Interestingly, the notice says you “could qualify for a modest positive payment adjustment.”  I am surprised by that because one would think you would be eligible for the full four percent.  Because of the lack of detail in the notice, I can’t tell you more. The Fourth and final Option is to Participate in an Advanced Alternative Payment Model in 2017.  Here, you don’t report quality data and other information.  If you are in one of the narrowly defined Advanced Alternative Payment Models, such as Medicare Shared Savings Track 2 or 3 in 2017and receive enough of your Medicare payments or see enough of your Medicare patients through an Advanced Alternative Payment Model in 2017, you can receive up to 5 percent of a payment increase in 2019. \ 

This is really just a preview of what will appear in the final rule right around Halloween.  

Trick or Treat? 

About the Author 

David M. Glaser, Esq., is a shareholder in Fredrikson & Byron’s Health Law Group. David helps clinics, hospitals, and other healthcare entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David’s goal is to explain the government’s enforcement position and to analyze whether the law supports this position. David is a popular panelist on Monitor Mondays and is a member of the RACmonitor editorial board.

Contact the Author 

dglaser@fredlaw.com 

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David M. Glaser, Esq.

David M. Glaser, Esq., is a shareholder in Fredrikson & Byron’s Health Law Group. David helps clinics, hospitals, and other healthcare entities negotiate the maze of healthcare regulations, providing advice about risk management, reimbursement, and business planning issues. He has considerable experience in healthcare regulation and litigation, including compliance, criminal and civil fraud investigations, and reimbursement disputes. David’s goal is to explain the government’s enforcement position and to analyze whether the law supports this position. David is a popular panelist on Monitor Mondays and is a member of the RACmonitor editorial board.

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