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CMS releases MACRA proposed final rule

The Wisconsin Medical Society has begun to review the 962-page MACRA proposed final rule, which was released yesterday by the Centers for Medicare and Medicaid Services (CMS).

MACRA—the Medicare Access and CHIP Reauthorization Act of 2015—repealed the Medicare sustainable growth rate (SGR) formula and replaces it with a new Quality Payment Program. The program, which will go into effect in 2019, will offer two paths for eligible providers: Merit-based Incentive Payment Systems (MIPS) and certain Alternative Payments Models (APM).

CMS expects that in the initial years most physicians will choose the MIPS path, which links payment to value and measures physicians in four areas: quality, cost, technology use and practice improvement. The performance measures will be developed over the next few years, and MIPS is expected to avoid redundancies by consolidating components of three existing programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record Incentive Program for achieving meaningful use for eligible professionals.

Medicare clinicians who participate to a sufficient extent in APMs would be exempt from MIPS reporting requirements and would qualify for financial bonuses. These models include the new Comprehensive Primary Care Plus (CPC+) model (see related Medigram article), the Next Generation Accountable Care Organization model, and other APMs under which clinicians accept both risk and reward for providing coordinated, high quality care.

CMS is accepting comments on the 962-page rule until June 27 and will publish the final rule this fall.

The American Medical Association has developed a number of resources to help physicians understand MACRA and prepare for this transition. Click here for more information.