Medicare Compliance & Reimbursement

As the Jan. 1 start date looms large, CMS gives choices to Medicare providers.

The final MACRA Quality Payment Program (QPP) rule makes its debut soon — will you be ready? Expect new forms, requirements, and payments as Medicare shifts from fee-for-service care to quality, patient-focused care.

Relief Comes to MACRA Adopters

CMS reveals in a new outline for the upcoming MACRA rollout that it is listening to the public’s outcry. Though the plan to launch the QPP is still in place, CMS is offering leveled immersion options for providers with trepidation.

“With the Quality Payment Program set to begin on January 1, 2017, we wanted to share our plans for the timing of reporting for the first year of the program,” said Andy Slavitt, CMS administrator, in a Sept. 8, 2016 blog post. “In recognition of the wide diversity of physician practices, we intend for the Quality Payment Program to allow physicians to pick their pace of participation for the first performance period that begins January 1, 2017.”

The Choice Is Yours

Background. With different components like practice size, location, patient load, and specialty factoring into the MACRA equation, providers have repeatedly stressed the worry that introducing the QPP too soon could be catastrophic. Slavitt, in his July 2016 testimony to Congress, suggested that CMS would approach the deadline slowly, giving QPP participants alternatives for investing in such a detailed and pervasive health care plan.

Four options to choose from. Whether you are all-in or want to test the waters, there is an entry point for you, particularly if you are worried about how this will affect your bottom line.

“During 2017, eligible physicians and other clinicians will have multiple options for participation,” Slavitt explains. “Choosing one of these options would ensure you do not receive a negative payment adjustment in 2019. These options and other supporting details will be described fully in the final rule.”

Here’s a brief overview of the four opportunities for MACRA involvement:

The lowest point of QPP adoption allows providers to give “some data” without any negative financial repercussions but allows adopters to ramp up their participation in following years after testing the MACRA waters.

For the second option, interested clinicians would enter the program partially starting Jan. 1, 2017 with the opportunity of a “small positive payment adjustment.”

For those ready on day one, the third course offers a full year of involvement in the QPP. EPs would present their data, and if their chosen measures are met, see a “modest payment adjustment.”

At the highest echelon of QPP adoption is engagement in the Advanced Alternative Payment Models (APMs). Advanced APMs would cover participation in programs like CMS Innovation Models like the Comprehensive Primary Care Plus (CPC+), which require a significant level of involvement; thus, affording the participants who “qualify, a 5 percent incentive payment in 2019.”

The AMA Commends CMS Changes

Since the QPP was first introduced in April, the American Medical Association (AMA) has been at the forefront of the commentary, offering CMS the physician’s perspective to ensure a smoother transition.

“By adopting this thoughtful and flexible approach, the Administration is encouraging a successful transition to the new law by offering physicians options for participating in MACRA,” said Andrew W. Gurman MD, AMA president in a Sept. 8, 2016 AMA press release. “This is the flexibility that physicians were seeking all along.” (Link here: http://www.ama-assn.org/ama/pub/news/news/2016/2016-09-08-ama-praises-administration-macra-changes.page)

Looking ahead. Whether your practice is planning on dipping your toes in or diving head first, CMS is forging ahead with patient-centered care as its focus on the Medicare horizon. Consider the options and look for more news ahead in the days leading up to the new year.

To take a closer look at the QPP options, read https://blog.cms.gov/2016/09/08/qualitypaymentprogram-pickyourpace/.