Temporary Transition Policies Reduce Threat of Negative Adjustments in 2019, But Adds to Complexity
On November 4, 2016, the Centers for Medicare & Medicaid Services (CMS) is publishing a sweeping final rule reforming the Medicare physician fee schedule (MPFS) update framework, as mandated by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). Beginning in 2017, physicians can choose one of two tracks within the new “Quality Payment Program” to determine their MPFS update: reporting under the Merit-based Incentive Payment System (MIPS) or participation in an Advanced Alternative Payment Model (APM). A physician’s 2019 MPFS payment update (positive or negative) is based on action in 2017 – leaving little time to digest and prepare for the new framework before the system kicks in January 1, 2017. In order to give physicians and other affected clinicians additional flexibility going into 2017, CMS adopted several “transition” policies that will allow physicians to “pick their pace of participation” and report fewer quality measures, or report for a partial year and still avoid a negative payment adjustment in 2019, and possibly qualify for a positive adjustment.
The byproduct of the final rule’s additional flexibility is a dizzying complexity of requirements for avoiding negative adjustments in Medicare payment — the advance version of the final rule is almost 2,200 pages and more than twice as long as the May 2016 proposed rule. Moreover, CMS expresses its intention to further modify numerous provisions in future years as clinicians and CMS gain experience with the program. To that end, the agency is accepting comments on a wide range of provisions through December 19, 2016. Thus, even though CMS has at long last issued the final MACRA rule, the specific policies linking MIPS quality reporting and/or APM participation to actual Medicare payment adjustments may still be in flux for several years.
Reed Smith has prepared a summary of the final rule’s new payment framework and significant changes from the proposed rule.