10 things to know about CMS' final MACRA rule

Practice Management

Last week, CMS released its final Medicare Access & CHIP Reauthorization Act of 2015 implementation final rule, according to Healthcare Dive.

Here are 10 things to know:


1. The rule will get rid of the sustainable growth formula, replacing it with a 0.5 percent annual rate increase through 2019. After this time, CMS will encourage physicians to move to either the Merit-based Incentive Payment System or an Alternative Payment Model. Under MIPS, physicians will receive payments adjustments based on quality, cost and certified EHR use.


2. CMS will lower the MIPS performance threshold to a three-point threshold for the 2019 MIPS payment year.


3. CMS noted in its rule that physicians who have a final score of 70 or higher will be eligible for an "exceptional performance adjustment" from a pool totaling $500 million.


4. CMS' final rule increased the low-volume threshold to $30,000 in Medicare Part B charges or 100 Medicare patients.


5. Patrick Conway, MD, CMS' deputy administrator for innovation and quality, said nearly 380,000 providers could be exempt from MIPS, and CMS anticipated 25 percent of physicians to participate in advanced APMs in 2018. In the first year of MIPS, Dr. Conway said the agency expects 100,000 providers to participate.


6. HHS will allocate $20 million every year for five years to train and educate Medicare providers in small practices, comprised of 15 or less physicians, working in underserved areas.


7. Providers can choose from four options to participate in MIPS, which, as part of MACRA's Quality Payment Program, is set to begin Jan. 1 for the performance calendar year 2017. The options include:


•    Providers can submit "some data" for MIPS after Jan. 1, thereby avoiding a negative payment adjustment in 2019.  No incentive is earned for this option..
•    Clinicians can participate in the program for part of the calendar year. In the second option, providers can submit performance measures and improvement activity data across all required MIPS performance categories for a reduced number of days while still qualifying for a "small" positive payment adjustment.

•    Under the third option, providers submit data across all MIPS performance categories for the full calendar year and qualify for a "modest" positive payment adjustment.
•    Finally, the fourth option allows providers to join Advanced APMs in 2017. If providers sufficiently participate in Advanced APMs, they qualify for a 5 percent incentive payment in 2019 and are exempt from MIPS.


8. CMS plans to add the follow entities as Advanced APMs next year:


•    Comprehensive ESRD Care - Two-sided risk
•    Comprehensive Primary Care Plus (CPC+)
•    Next Generation ACO
•    Medicare Shared Savings Program - Tracks 2 and 3


9. MIPS' "Advanced Care Information" section replaces the meaningful use program. In this section, CMS lowers the total number of required measures from 11 to five measures. The five health IT measures include:


•    Security risk analysis
•    E-prescribing
•    Providing patient access
•    Sending summary of care
•    Requesting/accepting summary of care


A provider can also submit optimal measures to potentially obtain a higher score.


10. CMS is taking comments on the rule for 60 days. CMS Acting Administrator Andy Slavitt said, "We're not looking to transform the Medicare program in 2017. We're looking to make a long-term program successful."


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