The CMS (Centers for Medicare and Medicaid Services) has issued a draft policy outlining how the agency will utilize quality measures to encourage the transition to a latest Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs) for contributors.
The Medicare Access and CHIP Reauthorization Act of the year 2015 (MACRA), approved by Congress previous this year, repealed the Medicare sustainable progress rate methodology for updates to the physician fee routine and replaced it with MIPS and APMs. MACRA efficiently sunsets payment adjustments for 3 existing clinician reporting and incentive programs—Physician Quality Reporting System (PQRS), the Meaningful Use Electronic Health Record Incentive Program, and Value-based Payment Modifier (VM) for eligible experts.
“The PQRS, VM, and EHR Incentive Program plans have each played a significant role in the early progress of physician-based quality measurement and claiming in the Medicare program,” claims the draft policy. “Although, to lessen contributor burden, CMS finds to optimize efficiencies through larger alignment across these plans”
The draft Quality Measure Development Plan issued on Friday by CMS concentrates on gaps recognized in the quality measure sets presently in use in PQRS, VM and Meaningful Use, providing suggestions for filling these spaces.
“To fill recognized measure and performance space areas, CMS will extend and increase existing measures to launch alignment and harmonization in the selection of measures and specifications, while concurrently establishing recent (de novo) measures,” says the draft policy.
In accordance to CMS, initiating in the year 2019 the agency will implement a positive, negative, or neutral payment adjustment to per MIPS eligible expert deployed on a composite performance score across 4 performance sections: quality, resource utilization, clinical practice improvement activities, and meaningful use of certified EHR technology.
“MACRA constitutes incentive payments for EPs engaging in certain kinds of APMs,” the policy claims. “MACRA needs quality measures utilized in APMs to be comparable to the quality measures used in MIPS; therefore applicability of candidate measures to reinforce a variety of upcoming APMs is a significant element.”
For its part, the AMA (American Medical Association) has expressed its uncertainties about executing MACRA, alerting CMS that key hurdles in the Meaningful Use program are standing in the way of shifting the healthcare industry to MIPS and APMs.
“Program flexibility is the important factor in making better the Meaningful Use program, making certain that Level 3 objectives can align with advanced payment models,” claims AMA in a Dec. 15 letter to Acting CMS Administrator Andrew Slavitt and National Coordinator for Health Information Technology Karen DeSalvo, M.D. “Latest payment networks will not work if physicians fail for missing merely one of numerous needs or are held accountable for technological failures outside of their control.”
An AMA spokesman claimed the agency is presently considering the draft CMS Quality Measure Development Plan and does not have a comment at this time.
CMS is soliciting comments on the draft policy from contributors, payers, and consumers through the time of March 1, 2016. The final policy, deployed on public comments to the draft policy, will be posted on the CMS website by the time of May 1, 2016.
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