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CMS Reveals 4 Options for Quality Payment Program Participation

Next year, healthcare providers can participate in the quality payment program under MACRA legislation using any of four different options.

By Vera Gruessner

The Centers for Medicare & Medicaid Services (CMS) is working toward assisting healthcare providers in meeting some new regulations that are part of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The meaningful use program is slowly being replaced by MACRA and its quality payment program in order to better manage the large and aging baby boomer population.

MACRA Legislation

Andy Slavitt, CMS Acting Administrator, wrote for The CMS Blog, that more than 10,000 beneficiaries enter the Medicare program every day due to the aging baby boomer population. As such, it is imperative for CMS to work with physicians and hospitals to support high quality care and strong patient outcomes, which includes removing obstacles in the way of doctors practicing their skill.

MACRA legislation reforms Medicare payments

The quality payment program under MACRA assist in meeting these goals, explains Slavitt. The legislation has repealed the Sustainable Growth Rate Formula, which means that the prior “payment cliffs” are no longer an issue. On the other hand, providers are now being geared toward receiving payments due to better care through value-based care reimbursement policies.

CMS has taken into account physician perspectives on technology and how excessive data reporting could take away from quality care. CMS will be reviewing many of the proposed comments to MACRA and addressing issues when the agency releases the final rule for the quality payment program on November 1, 2016.

READ MORE: CMS Solicits Payer Participation to Next Phase of CPC+

“Our particular focus on meeting with practicing physicians in their offices, in workshops, in focus groups and in weekly sessions to listen to policy options and to dig into the details of how the concepts in MACRA translate into the realities of a busy practice. Since proposing the rule at the end of April, we’ve held over 135 events centered on physicians and clinicians affected by the Quality Payment Program,” the CMS Acting Administrator said in a statement.

The quality payment program is expected to start January 1, 2017 and Slavitt outlined four different options in which providers can participate in the MACRA regulations next year to qualify for payments within the Medicare program.

Four options for MACRA participation

First, providers can test the quality payment program by submitting data starting on or after January 1, 2017. This would ensure that physicians and other healthcare providers do not face a negative payment adjustment. Beginning the program by testing it out would allow providers to prepare for more broad participation in following years.

The second option for providers includes participating in the quality payment program for a portion of the year instead of the entire annual cycle. Physicians and healthcare practices can begin participating after the first of January, which would still qualify them for a small positive payment adjustment.

READ MORE: Doctors Provide 5 Alternative Payment Model Improvements

Some of the information that providers may need to submit include data about their technology use and quality improvement initiatives. When participating for part of the year, providers can choose which quality measures to follow from a list CMS provides.

The third option that physicians and providers can take include participating in the quality payment program for an entire year. This means that physicians and other clinicians will need to have their practices ready to begin submitting quality payment data to CMS on January 1, 2017.

A more “modest positive payment adjustment” could be garnered if participants supply data on technology use, quality measures, and quality improvement processes over the entire year, wrote Slavitt.

The fourth option is the most progressive in which healthcare providers can participate in an Advanced Alternative Payment Model next year. This includes participating in either the Medicare Shared Savings Track 2 or 3 in 2017, says Slavitt.

If enough Medicare beneficiaries are seen through this advanced model, the healthcare providers can actually be eligible for a 5 percent incentive payment by 2019. In an interview with, Richard F. Bajner, Jr., Managing Director at Navigant, discussed the impacts of the MACRA legislation.

READ MORE: CMS Seeking Feedback on Pediatric Alternative Payment Model

“Under MACRA, there are two components: the MIPS component and the APM component,” Bajner explained. “Under MIPS, there are several different measures to evaluate. As more physician groups are looking at MIPS, they’re considering how to move more of their revenue at risk so that they can implement alternative payment models.”

“I think the payers can align with physician groups and healthcare organizations when these groups are considering alternative payment methodologies,” he continued. “This goes beyond the Medicare space to include commercial payment models so that there is economic alignment across all lines of business.”

“Commercial payers have an important role in helping drive such alignment as Medicare is moving its payment systems,” Bajner added. “Therefore, physician groups cannot say that they have one foot in fee-for-service and one foot in value; they need to have both feet in fee-for-value. That could help accelerate movement for physician groups.”

CMS has definitely pushed providers toward adopting value-based care protocols in recent years. Whichever choice is taken by a provider out of the four options, CMS is available to assist with questions and resources to ensure success in the quality payment program over the coming years.

In the meantime, click here to learn more about the MACRA legislation.


Dig Deeper:

How Payers Should Prepare for Value-Based Reimbursement

MACRA’s Merit-Based Incentive Payment System Removes SGR Flaws


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