CMS has issued a Proposed Rule for its new Quality Payment Program, which was established by the Medicare Access and CHIP Reauthorization Act (MACRA) of 2015 to replace the Sustainable Growth Rate reimbursement formula.  The new program rewards value and quality of care through two pathways:

  • Merit-based Incentive Payment System (MIPS)
  • Advanced Alternative Payment Models (APMs)

Most clinicians will participate initially in MIPS, which replaces the Physician Quality Reporting System, the Value Modifier Program, and the EHR Incentive Program (Meaningful Use).  According to CMS, MIPS will allow clinicians to be paid for providing high quality, efficient care through success in four performance categories:

  • Cost
  • Quality
  • Clinical practice improvement activities
  • Advancing care information

Alternatively, clinicians may opt to participate in Advanced APMs, such as the Comprehensive ESRD Care Model, Comprehensive Primary Care Plus (CPC+), or the Next Generation Accountable Care Organization (ACO) Model.  Clinicians who meet Advanced APM participation requirements are exempt from MIPS payment adjustments and will qualify for a 5% incentive payment.
For more information about the CMS proposals, please see the 14-page Fact Sheet on the CMS website.
CMS will be accepting comments on the Proposed Rule until June 26.