Proposed Regulation on Physician Payments (MACRA) Released

April 29, 2016

On April 27, 2016 the Centers for Medicare & Medicaid Services (CMS) released proposed regulation on key elements of the Medicare Access and CHIP Reauthorization Act of 2015, otherwise known as MACRA. MACRA is bipartisan legislation enacted last year to repeal and replace the much-maligned Sustainable Growth Rate on physician payments under Medicare. 

Under MACRA, eligible providers, including physicians and other health professionals, will operate under one of two programs—the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs). 

“Development and implementation of MIPS and APMs will have a significant impact, not only on physicians, but also on the hospitals and health systems with whom they partner,” said WHA President/CEO Eric Borgerding. “That is why WHA continues to be actively engaged with CMS in the regulatory process as well as helping our membership prepare for this new payment system.” 

Under MIPS, CMS proposes a series of measures, activities, reporting, and data submission standards across the four performance categories: quality, resource use (ie: efficiency), clinical practice improvement activities, and meaningful use of certified electronic health record technology. CMS proposes eliminating meaningful use for providers and replacing it with what it calls “advancing care information.” Measures and activities would vary by category and include outcome measures, performance measures, and global and population-based measures.

Under APMs, CMS proposes only APMs that bear financial risk or are a specified medical home will qualify for incentive payments. Current eligible models that would qualify include Tracks 2 and 3 of the Medicare Shared Savings Program (MSSP) and the Next Generation ACO model. However, Track 1 of the MSSP and other potential programs would not qualify as APMs if they fail to meet certain risk thresholds. The newly-announced Comprehensive Primary Care Plus initiative would qualify as a medical home. 

The Wisconsin Hospital Association continues to review the proposed rule and will submit detailed comments to CMS by the June 27 deadline. Watch future Valued Voice articles for ongoing information and details.

This story originally appeared in the April 29, 2016 edition of WHA Newsletter