CMS Proposes New Rule for Quality Payment Program Under MACRA

The Centers for Medicare and Medicaid Services (CMS) has issued a 962-page proposed rule covering implementation of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). The goal, said CMS in a statement, is “a new framework for rewarding health care providers for giving better care, not just more care.”

MACRA replaces the flawed Medicare sustainable growth rate (SGR) formula and modifies and streamlines related quality reporting and electronic health record (EHR) programs. In its place now are two pathways for payment: through the Merit-Based Incentive Payment System (MIPS) or Alternative Payment Models (APMs).

Beginning with reporting in 2017, physicians will receive a composite performance score (CPS) based on how they perform in comparison to an average for other professionals. The CPS will determine maximum payment bonuses and penalties, which will range from 4% in 2019 to 9% starting in 2022. The program measures providers on the basis of quality, resource use, clinical practice improvement, and meaningful use of certified EHR technology (now referred to advancing care information).

Physicians who have sufficient revenue tied to “eligible” APMs can qualify for 5% bonuses and exemption from MIPS reporting requirements. APMs include accountable care organizations, patient-centered medical homes, and bundled payment models.

Aspects of the rule that may be relevant for psychiatry include exemption of “low-volume” providers from MIPS reporting or penalties, the ability of small practices to join together for joint reporting and assessment, flexibility for scoring within MIPS categories, and funding for technical assistance for small practices. There are also advantages for doing MIPS reporting through clinical data registries. APA is now beginning work on the development of a mental health clinical data registry.

“APA supports providing quality care to our patients,” said APA CEO and Medical Director Saul Levin, M.D., M.P.A. “The APA administration will be analyzing the rule and sharing with our membership how it will affect psychiatric care. We will also provide our members with the tools they will need to meet the new requirements.”

CMS will accept comments on the rule until June 27, and a final rule is expected to be issued by November 1.

For more information, see a brief summary of the rule and a fact sheet with links to additional information.

For more in Psychiatric News about MACRA, see “Value-Based Payment Will Change Practice, Reimbursement.”