CMS Finalizes New Medicare Quality Payment Program: “Flexibility” and “Pick Your Pace” Key Themes

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After receiving roughly 4,000 comments to its proposed rule, the Centers for Medicare and Medicaid Services (CMS) on October 14, 2016 released its final rule for implementing the Medicare Access and CHIP Reauthorization Act (MACRA). MACRA replaced the sustainable growth-rate formula for physician reimbursement with a new methodology to transition providers from volume to value-based reimbursement. This new approach to payment – called the Quality Payment Program – is a major departure from traditional fee-for-service reimbursement in that it rewards the delivery of high-quality care through Advanced Alternative Payment Models (Advanced APMs) and the Merit-based Incentive Payment System (MIPS) for “eligible clinicians” and groups.

MIPS will consolidate components of three existing programs: the Physician Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare Electronic Health Record (EHR) Incentive Program for Eligible Professionals (EPs), and will continue to focus on quality, cost, and use of certified EHR technology (CEHRT) in a cohesive program that avoids redundancies. The proposed rule generated a multitude of comments and