Deep Dive Into Proposed MACRA Rule

As we recently reported, CMS published their proposed rule to update the MACRA Quality Payment Program (QPP). The QPP is a part of a fundamental shift from fee-for-service to a more value-based health care system. Below, we offer a more in-depth look at the proposed rule.  Some Major Points MACRA eliminated the sustainable growth rate formula and replaced it with a 0.5% rate increase through 2019. Physicians are encouraged to pick one of two Quality Payment Programs: 1) the Merit-based Incentive Payment System (MIPS) or 2) Alternative Payment Models (APMs). MIPS folds together CMS legal programs of Meaningful Use, the Physician Quality Reporting System, and the Value-based Payment Modifier. Under MIPS, physicians receive positive, negative, or neutral payment adjustments based on quality, cost, improvement activities, and the use of electronic health records. One of the biggest take away points from the rule is the note from CMS that only 36% of clinicians will be eligible for MIPS after all exclusions, although they make up 58% of Medicare Part B charges. Flexibility is another major component in the proposed rule. For example, CMS increased the low-volume threshold to $90,000 or less in Medicare Part B charges or 200 or fewer Medicare patients annually. The original threshold was $30,000 in Medicare Part B charges or 100 Medicare patients. Between this year's exemption and the proposed one for next year, the move will exclude a total of about 834,000 more clinicia...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs