CMS Tells How it Would Support New Payment Models

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The Centers for Medicare and Medicaid Services has released a draft plan outlining how the agency will use quality measures to support the transition to a new Merit-based Incentive Payment System (MIPS) and alternative payment models (APMs) for providers.

The Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), passed by Congress earlier this year, repealed the Medicare sustainable growth rate methodology for updates to the physician fee schedule and replaced it with MIPS and APMs. MACRA effectively sunsets payment adjustments for three existing clinician reporting and incentive programs—Physician Quality Reporting System (PQRS), Value-based Payment Modifier (VM), and the Meaningful Use Electronic Health Record Incentive Program for eligible professionals.

“The PQRS, VM, and EHR Incentive Program programs have each played an important role in the early development of physician-based quality measurement and reporting in the Medicare program,” states the draft plan. “However, to reduce provider burden, CMS seeks to optimize efficiencies through greater alignment across these programs”

The draft Quality Measure Development Plan released on Friday by CMS focuses on gaps identified in the quality measure sets currently in use in PQRS, VM and Meaningful Use, offering recommendations for filling these gaps.

“To fill identified measure and performance gap areas, CMS will expand and enhance existing measures to promote alignment and harmonization in the selection of measures and specifications, while concurrently developing new (de novo) measures,” states the draft plan.

According to CMS, starting in 2019 the agency will apply a positive, negative, or neutral payment adjustment to each MIPS eligible professional based on a composite performance score across four performance categories: quality, resource use, clinical practice improvement activities, and meaningful use of certified EHR technology.

“MACRA establishes incentive payments for EPs participating in certain types of APMs,” the plan states. “MACRA requires quality measures used in APMs to be comparable to the quality measures used in MIPS; therefore applicability of candidate measures to support a variety of future APMs is an important element.”

Also See: Value-Based Payment Requires Outcome Measures, AMIA Says

For its part, the American Medical Association has expressed its concerns about implementing MACRA, warning CMS that significant barriers in the Meaningful Use program are standing in the way of moving the healthcare industry to MIPS and APMs.

“Program flexibility is the key factor in improving the Meaningful Use program, ensuring that Stage 3 objectives can align with advanced payment models,” states AMA in a Dec. 15 letter to Acting CMS Administrator Andrew Slavitt and National Coordinator for Health IT Karen DeSalvo, M.D. “New payment systems will not work if physicians fail for missing just one of numerous requirements or are held accountable for technological failures outside of their control.”

An AMA spokesman said the organization is currently reviewing the draft CMS Quality Measure Development Plan and does not have a comment at this time.

CMS is soliciting comments on the draft plan from providers, payers, and consumers through March 1, 2016, which can be made online here. The final plan, based on public comments to the draft plan, will be posted on the CMS website by May 1, 2016.

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