HHS proposes streamlined rules for how Medicare pays physicians, formally replaces meaningful use

Acting Centers for Medicare and Medicaid Services chief Andy Slavitt.

In a proposed rule released Wednesday, the Department of Health and Human Services proposes streamlining the current patchwork system of reform used in Medicare payments to physicians.

If finalized, the rule would replace the current meaningful use program for physicians who participate in Medicare, according to Andy Slavitt, acting administrator for the Centers for Medicare and Medicaid Services.

The proposal affects only Medicare payments to physician offices, not Medicare hospitals or Medicaid programs.

However, Health and Human Services officials are already meeting with hospitals to discuss potential opportunities to align the programs and are engaging with Medicaid stakeholders as well, according to HHS.

The more flexible Quality Payment Program for physicians is aimed at reducing the reporting burden and offers financial incentives. The aim is for it to be patient-centered, practice driven, and as simple as possible for physicians, Slavitt said.

Physicians may choose two options: The Merit-based Incentive Payment System (MIPS); or the Advanced Alternative Payment Models (APMs).

Over time, physicians can move from one to the other, said Patrick Conway, principal deputy administrator and chief medical officer for CMS. During the first year, most Medicare physicians will participate through MIPS, he said, with more expected over time to join the APM model with it's larger financial incentives.

Physicians that do well in MIPS can earn more than a 4 percent bonus, Conway said.

MIPS pays for providing high value care through success in four categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost.

Quality is 50 percent of the total score. Clinicians can choose to report six measures from among a range of options that accommodate differences among specialties and practices.

Advancing Care Information is 25 percent of the score in year 1. Clinicians would choose to report customized measures that reflect how they use technology in their day-to-day practice, with a particular emphasis on interoperability and information exchange.

Unlike the existing reporting program, this category would not require all-or-nothing EHR measurement or redundant quality reporting, HHS said.

Clinical Practice Improvement Activities, which is 15 percent of the total score in year 1, rewards clinical practice improvements, such as activities focused on care coordination, beneficiary engagement, and patient safety. Clinicians may select activities that match their practices' goals from a list of more than 90 options.

Cost is 10 percent of total score in year 1. The score is based on Medicare claims, meaning no reporting requirements for clinicians. This category would use 40 episode-specific measures to account for differences among specialties.

CMS would begin measuring performance for doctors and other clinicians through MIPS in 2017, with payments based on those measures beginning in 2019.

The alternative payment model would give Medicare clinicians who participate to a sufficient extent an exemption from MIPS reporting requirements and they would qualify for financial bonuses. 

These models include the new Comprehensive Primary Care Plus model and the Next Generation ACO model and other alternative payment models in which clinicians accept both risk and reward for providing coordinated, high-quality care.

Medicare Advantage may count as an alternative payment model in future years. For the first two years, HHS is focused on traditional Medicare, and then for 2021, the payment adjustment, based on the 2019 performance period, could include Medicare Advantage payment to providers, or Medicaid or commercial payment to providers, Conway said.

HHS will accept comments until June 26, 2016.

The new rule is the first step in implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

The American Medical Association responded Wednesday.

"It is hard to overstate the significance of these proposed regulations for patients and physicians," said AMA President Steven Stack. "Our initial review suggests that CMS has been listening to physicians' concerns. In particular, it appears that CMS has made significant improvements  by recasting the EHR Meaningful Use program and by reducing quality reporting burdens."

Conway said, "By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice, and their patients."