CMS Quality Payment Programs are a key element of CMS’ effort to transform the Medicare system from a “Pay for Volume” model to “Pay for Value”. The Quality Payment Programs include Alternative Payment Models (APMs) such as ACOs and Patient Centered Medical Homes (PCMH). For physician practices not participating in an APM, the Merit-Based Incentive Payment System (MIPS) will apply. MIPS, which will be effective 1/1/2017, incorporates the legacy Meaningful Use, PQRS and Value Modifier programs.
New for MIPS in 2018 is the “Significant Hardship Exception” for small practices, which exempts them from the “Promoting Interoperability” category. While claiming the exception will reduce cost and labor, practices should do a breakeven analysis to determine if it is profitable to complete the PI category.
CMS has renamed its various EHR incentive programs to “Promoting Interoperability”. The Meaningful Use and Advancing Care Information names will be dropped.
The CMS Merit-Based Incentive Payment System (MIPS) rules have changed for 2018, and the financial impact for physician practices has edged higher. Based on performance in 2018, physician reimbursement for Medicare Part B in calendar year 2020 will be reduced by as much as 5%.
The Security Risk Analysis (SRA) remains a requirement for the new Advancing Care Information (ACI) category of MIPS. A change enacted this year requires that the SRA be complete by 12/31/2017 under ACI, the Medicaid Meaningful Use program for physicians, and Hospital Meaningful Use programs. Practices who need outside help are advised to schedule their early to ensure that it is completed on time, and to avoid
While most of the political attention has focused on the GOP and Trump administration’s efforts to repeal Obamacare, aging Baby Boomers continue to challenge the finances of Medicare and the entire U.S. Federal budget. After the recent passage of an Obamacare repeal bill in the House, it is likely that political attention will remain on Obamacare repeal efforts, leaving recently enacted programs affecting Medicare, MACRA and MIPS, intact. It is possible that practices who maximize their performance under MIPS could earn a big payday, as high as