On April 16, 2015 the President signed legislation to repeal the Medicare sustainable growth-rate (SGR) formula for paying doctors. This repeal, of course, was welcomed by the physician community tired of the annual fight to restore reimbursement.
Also included in this legislation is a repeal, effective in 2018, of the existing penalty structure for those not participating in meaningful use. These penalties, which by 2019 were to be as high as 5% of Medicare payments, will be replaced with an incentive payment program designed to focus the fee-for service system on providing value and quality. This incentive payment program, called the Merit-Based Incentive Payment System (MIPS), consolidates three existing incentive programs. MIPS will assess physicians in four categories:
- Quality
- Resource Use
- Meaningful Use
- Clinical Practice Improvement Activities
Based on a provider’s performance, this system will adjust their Medicare payments with either negative adjustments (which will grow from 4% in 2019 to as high as 9% by 202) or positive adjustments of up to three times the negative adjustment amounts.
The full details will be developed and we will keep you updated as specifics emerge, which may be a year or two away.
Editor’s Note: Subsequent to the publication of this article, CMS has renamed the “Meaningful Use” programs and MIPS “Advancing Care Information” category to “Promoting Interoperability”.
