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New Medicare Rules Would Increase Bonus Opportunities, Ease Reporting

By MedPage Today  
   April 28, 2016

CMS chief medical officer Patrick Conway, MD, said "The proposed system would reward clinical practice improvements such as activities focused on care coordination, patient engagement, and patient safety, and also reduce reporting requirements... by reducing the number of measures required, and eliminating redundant quality reporting. From MedPage Today.

The Obama Administration proposed two rules Wednesday that officials say will ease physicians' documentation requirements and give them new opportunities to earn bonuses for providing high-quality care.

One rule implements what is called the Quality Payment Program, which gives doctors two options for getting reimbursed under Medicare: they can participate either in the Merit-Based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

"There have been a myriad of programs [for physician payment] developed over the years," Andy Slavitt, acting administrator of the Centers for Medicare & Medicaid Services (CMS), told reporters on a conference call. He gave alternative programs such as accountable care organizations and shared savings programs as examples. The Quality Payment Program "replaces all these programs with a single platform. Physicians will have the opportunity to get paid more for investments that support patients, and do so with minimal burden."

In addition, said CMS chief medical officer Patrick Conway, MD, "The proposed system would reward clinical practice improvements such as activities focused on care coordination, patient engagement and patient safety, and also reduce reporting requirements ... by reducing the number of measures required, and eliminating redundant quality reporting. If physicans do well in the program, they could earn more than a 4% bonus in incentive payments ... with additional bonuses for the highest performers."


Related: CMS: Meaningful Use for Physicians Would End in 2017


Physicians choosing the MIPS program would get paid based on their reporting on a single set of quality measures; the set combines measures from earlier programs such as the Physician Quality Reporting System and the Value-Based Payment modifier. However, to increase flexibility, "The program allows physicians ... to select quality measures from a range of options to reflect differences among specialties, and report technology utilization based on customizable measures that reflect how clinicians use technology in their day-to-day practice," Conway explained.

Those choosing the Advanced APM program would be paid based on their participation in newer payment models such as the Comprehensive Primary Care Plus model and the Next Generation Accountable Care Organization model.

Both programs are slated to go into effect in January 2017, beginning with a reporting period that will affect physician pay in 2019.

The second proposed rule makes changes to the highly unpopular Meaningful Use program, which requires physicians to document making "meaningful use" of electronic health records (EHRs). "We are proposing to replace Meaningful Use with a new effort that moves the emphasis away from the use of information technology to one that supports patient care that is supported by better and more connected technology," Slavitt said on a second conference call. "The program, Advancing Care Information (ACI), is designed to be more flexible and less burdensome," and would also take effect in January 2017, he said.

The ACI program "will allow physicians and other clinicians to select measures to reflect how [information] technology best suits their day-to-day practice; the proposal eliminates a number of measurements and entirely focuses on patient care and connectivity goals," Slavitt said. "The proposal allows 'acknowledgement reporting' to comprise 50% of the program, and it removes the all-or-nothing grading system. It also aligns with other quality and reporting programs, so it's simpler."


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