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CMS Proposes Updates to Quality Payment Program

Changes aim to make it easier for small and rural providers to participate

The Centers for Medicare and Medicaid Services (CMS) has issued a proposed rule that would make changes in the second year of the Quality Payment Program, as required by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The agency’s goal is to simplify the program, especially for small, independent, and rural practices, while ensuring fiscal sustainability and high-quality care within Medicare, according to a press announcement.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said CMS Administrator Seema Verma. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

The Quality Payment Program, updated annually as part of MACRA, is meant to promote greater value within the health care system. Clinicians who participate in Medicare serve more than 57 million seniors. They can choose how they want to participate in the Quality Payment Program based on their practice size, specialty, location, or patient population.

In addition to amending some existing requirements, the proposed rule contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either advanced alternative payment models (APMs) or the merit-based incentive payment system (MIPS).

In addition, the CMS has used clinician feedback to shape the second year of the program. If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to health care delivery, according to the press release.

Moreover, the CMS is making it easier for rural and small providers to participate.

FierceHealthcare has listed some of the major changes proposed under the rule:

  • Increases the MIPS’s low-volume threshold, thereby exempting more than 585,000 clinicians from the program and its reporting requirements. The CMS will increase the threshold to exclude clinicians or groups from those with $30,000 to $90,000 in Part B charges or with fewer than 100 to 200 Part B beneficiaries.
  • Offers a virtual groups participation option under the MIPS. Virtual groups would be composed of solo practitioners and groups of 10 or fewer clinicians eligible to participate in the MIPS who come together “virtually” with at least one other such solo practitioner or group to participate in the MIPS for a performance period of one year.
  • Continues to allow the use of the 2014 version of certified electronic health record technology, while encouraging the use of the 2015 version.
  • Adds flexibilities for clinicians in small practices, including a new hardship exception under the Advancing Care Information performance category.
  • Allows flexibilities for clinicians who are considered hospital-based or have limited face-to-face encounters with patients.
  • Puts in place new policies related to clinicians’ ability to earn incentives for participation in advanced APMs.

Sources: CMS; June 20, 2017; and FierceHealthcare; June 20, 2017.

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