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HHS takes first step toward modernizing Medicare payments

HHS this week released a proposal updating how Medicare payments are tied to the cost and quality of care, a move the department called the “first step” toward implementing certain provisions in the Medicare Access and CHIP Reauthorization Act of 2015.

Rather than the current patchwork of programs currently in place measuring the value and quality of care, the proposed rule would implement previous efforts by Congress to streamline those programs through a framework called the Quality Payment Program. The program includes two paths: The Merit-based Incentive Payment System (MIPS) and Advanced Alternative Payment Models (APMs).

“We are working with the medical community to advance our collective vision for Medicare payment reform,” Patrick Conway, MD, CMS acting principal deputy administrator and chief medical officer, said in a press release. “By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice and their patients. Reducing burden and improving how we measure performance supports clinicians in doing what they do best — caring for their patients.”

According to HHS, most Medicare clinicians will initially participate in the Quality Payment Program through MIPS, which will allow them to be paid for providing high value care through four performance categories: quality, advancing care information, clinical practice improvement activities and cost.

The proposed rule aims to streamline and reduce reporting burden across these categories, according to HHS. CMS would begin measuring performance for physicians and clinicians through MIPS in 2017, with payments based on those results beginning in 2019.

For those participating in alternative payment models through the Affordable Care Act, MACRA created additional rewards for clinicians who take further steps toward care transformation, HHS said. In addition, those who take part in APMs to a sufficient extent would be exempt from MIPS reporting requirement and qualify for financial bonuses. APM programs include the Comprehensive Primary Care Plus (CPC+) model and the Next Generation ACO model.

HHS plans to access feedback and comments on the proposed rule until June 27, 2016.

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