HHS Issues Proposed Rules Implementing MACRA


When Congress passed the Medicare Access and CHIP Reauthorization Act (MACRA) in March 2015, a victory was handed to the physician community. It marked the end of the Sustainable Growth Rate (SGR) that, for many years, plagued the physician payment system. While the intent of MACRA—to transition Medicare reimbursement from a volume-based system to a value-based system, and to consolidate the patchwork of quality measurement programs—is laudable, its passage brought with it newfound uncertainty about how this new world would impact physicians, specifically smaller, independent practices, and the delivery of care.

On April 27, the U.S. Department of Health and Human Services (HHS) issued a proposed rule to clarify and hopefully reduce the uncertainty regarding the changes prescribed by MACRA. Most notably, the majority of physicians participating in the Medicare program would initially participate in the Merit-Based Incentive Program (MIPS), which consolidates the Physician Quality Reporting System (PQRS), the Value-Based Modifier (VM) and the Meaningful Use Electronic Health Records programs into one program. A physician’s MIPS score would be based on meeting selected metrics in four categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities and Cost. The proposed rule also seeks to streamline and reduce the reporting burden across all four categories, while adding flexibility for physician practices. The Centers for Medicare and Medicaid Services (CMS) would begin measuring physician performance through MIPS in 2017, with payments based on those measures beginning in 2019. (AAFP called on CMS to consider using 2018 as the initial assessment period). Read more.

Physicians who meet certain requirements for participation in Advanced Alternative Payment Models (APMs)—such as the new Comprehensive Primary Care Plus (CPC+) model and the Next Generation Accountable Care Organization model—would be exempt from MIPS reporting requirements and qualify for financial bonuses.

In anticipation of the federal rule promulgation associated with MACRA, the American Academy of Family Physicians (AAFP) wrote a letter to CMS Acting Administrator Andy Slavitt on April 11, citing the Academy’s priorities. The letter highlights the value of primary care services in the Medicare Physician Fee Schedule, focusing specifically on the pending proposed rule’s definition of the Patient Centered Medical Home; establishment of the performance year(s); primary care alternative payment models; meaningful use; per beneficiary primary care physician payments and care management fees; core performance measures; patient attribution and clinical practice improvement activities. The AAFP also signed on, with 40 other organizations, to a letter sent to CMS that presents four specific recommendations the organizations would like reflected in the proposed rules.

HHS is accepting public comment on the proposed rule until June 26, 2016. AAFP is in the process of reviewing and drafting a response to the 962-page "Medicare Program: Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models," and will be accepting feedback from state chapters. If you have input you would like included in the feedback that MAFP submits to AAFP on behalf of the membership, please email MAFP Director of Government Affairs Christin Nohner at AAFP's final response to HHS will be shared with the membership within the next few weeks.

CMS released additional information along with the proposed rule, including this blog by CMS Acting Administrator Slavitt; this video that explains, in layman's terms, the new Medicare Quality Payment Program; and this Q&A.