The Centers for Medicare & Medicaid Services (CMS) today released the agency's final rule detailing the Quality Payment Program (QPP), which, under the Medicare Access and CHIP Reauthorization Act (MACRA), changes the way physicians are reimbursed for services provided under Medicare Part B.
QPP creates two pathways for clinicians in the overall transition from the current fee-for-service-based Medicare reimbursement system to a high-quality, high-value, patient-centered reimbursement system under MACRA. The first path, the Merit-based Incentive Payment System (MIPS), rewards clinicians for providing high-quality care. The second path, Advanced Alternative Payment Models (APMs), reward clinicians for working together on coordinated, high-quality care for their patients.
In general, CMS sought to respond to the feedback received from across the medical community, and make substantive changes to reduce the reporting burden and facilitate transition to alternative payment models. ASCO is still analyzing rule and will provide more comprehensive details and guidance in the coming weeks. Key provisions for the oncology community in the nearly 2,400-page rule include allowing for more flexibility than anticipated by extending the MACRA transition period until at least 2018. For example, the weight of several performance reporting requirements on MIPS scores has been reduced during the transition period—in fact, resource use has been reweighted to zero for 2017. In other words, physicians will be evaluated on their 2017 resource use in 2018, but that data will not affect their MIPS score or their reimbursement in 2019.
Also as part of the transition period, CMS will allow practices to “pick their pace” for reporting. Based on their readiness, oncologists can avoid penalties by reporting on at least one measure in the quality, advancing care information and meaningful use categories; report for measures in all categories for at least 90 days; or report in all categories for the full year.
Small practices with a low-volume threshold—$30,000 or less in annual Medicare revenue or 100 or fewer Medicare patients—are exempt from all performance reporting in QPP. CMS estimates that 32.5 percent of physicians and other clinicians qualify for this exemption.
Bottom line: Those who report any quality data for at least 90-days of 2017 will be eligible for positive payment adjustments in 2019.The only physicians who will experience payment penalties in 2019 are non-exempt providers who choose to report no performance data for 2017.
The Oncology Care Model (OCM), a cancer care payment and service delivery model developed by the Center for Medicare & Medicaid Innovation, is named in the rule as an APM, and CMS is reviewing other existing payment models for consideration as APMs to allow more clinicians to join these types of initiatives. By 2018, CMS anticipates that around 25 percent of eligible clinicians will be in an APM.
In June, ASCO offered comments on the proposed MACRA implementation rule, and as a result of that feedback from ASCO and others, the general oncology specialty measure set is in the final rule. ASCO will again send feedback during the 60-day open comment period on the final rule, and will continue working with CMS throughout the entire MACRA implementation process.
Visit www.asco.org/MACRA for the latest resources and information on preparing oncology practices for the reimbursement and care delivery changes under MACRA. As you partner in practice, ASCO will also offer a webinar on the impact of the final rule. Stay tuned to ASCO in Action for details.