In testimony before the Subcommittee on Health of the U.S. House Committee on Energy & Commerce on March 17, 2016, Dr. Patrick Conway, Deputy Administrator for Innovation and Quality and Chief Medical Officer of CMS, discussed the implementation of physician payment reform, commonly known as the “permanent doc fix,” in the Medicare Access and CHIP Reauthorization Act of 2015 (“MACRA”). Among other provisions, under MACRA, beginning in CY 2019, physician payments will be subject to Medicare Incentive Payment System (“MIPS”) payment adjustments. Notably, Dr. Conway testified that MACRA “creates a high bar for eligible” alternative payment models (“APMs”) that physicians must participate in in order to be exempt from MIPS requirements. De. Conway said that many currently existing APMs, including those in the private sector as well as those established by the CMS Innovation Center, “are not likely to meet all … requirements” established by MACRA.
The new MIPS methodology will pay physicians using a performance-based score comprised of four categories: clinical quality, resource use, clinical improvement activities, and meaningful use of certified EHR. The payment methodology may result in an upward adjustment to a physician’s payment or a downward adjustment of up to 4 percent of the physician fee schedule amount in 2019, 5 percent in 2020, 7 percent in 2021 and 9 percent in 2022 and subsequent years.
To encourage participation in APMs, which CMS views as payment models that tie compensation to quality or value, MACRA exempts physicians participating in APMs from the new MIPS payment methodology and allows eligible professionals to receive an incentive payment. MACRA also statutorily defined an APM and established criteria for what qualifies as an “eligible APM.” Generally speaking, to be an eligible APM, MACRA requires that the APM require the use of certified EHR, base payment on quality similar to MIPS, and place participants at financial risk, which must be more than nominal financial risk.
Such APMs include, among others, Pioneer ACOs, Next Generation ACOs, the Medicare Shared Savings Program, the Bundled Payment Care Improvement Model, and the Comprehensive Primary Care Model. Dr. Conway further testified that it is CMS’s intent “to align the MIPS and APM components of the new payment system to the extent feasible.” CMS is currently in the process of gathering feedback and input from stakeholders as it works to develop proposed rules regarding certain aspects of MIPS and the framework for physician payments for those physicians participating in APMs.
On March 3, 2016, CMS released a fact sheet stating that it had created 10 alternative payment models that it believed contribute to the goal of tying at least 30 percent of Medicare FFS payments to quality or value.
A copy of the testimony is available here.
Reporter, Kate Stern, Atlanta, +1 404 572 4661, kstern@kslaw.com.
