The Department of Health and Human Services has published the final rule for the Medicare Access and CHIP Reauthorization Act (MACRA) Quality Payment Program, revamping physician reimbursement to reflect quality and efficiency of care, and making changes to the Electronic Health Records Meaningful Use Program.

The rule, designed to bring the industry into the realm of accountable and value-based care, comprises nearly 2,400 pages; HHS considered thousands of comments filed nationally after the proposed rule was first introduced in April.

“The Affordable Care Act created important tools to put individuals at the center of their own care and unlock access to healthcare data for patients and their clinicians,” according to a HHS statement. “Today’s announcement builds on this progress and makes our healthcare system work better for everyone.”

HHS Headquarters in Washington, D.C.
Brian M. Kalish/Employee Benefit Adviser

The rule replaces the long-maligned Sustainable Growth Rate formula, which was intended to moderate payments to the nation’s physicians. However, the SGR was a lightning rod for protests by national physician groups, and it provoked a series of deep cuts in payments that were regularly delayed or eliminated by federal lawmakers.

“With MACRA, Congress gave HHS the tools to keep improving how we pay for care so clinicians can focus on the quality of care they give, not the quantity of services they provide; and to keep moving the way care is delivered by encouraging better coordination and prioritizing wellness and prevention,” HHS officials said.

The final rule offers two paths for physicians transitioning from fee-for-service to alternative payment models. The first path enables those not ready for accountable care to still get paid more for higher quality of care; the second path is for clinicians ready for accountable care. HHS expects a quarter of eligible clinicians will be part of a more advanced alternative payment model by 2018.

Funding of $20 million annually for five years will support small practices, as well as clinicians practicing in underserved areas.

The final rule, available here, comes after a series of HHS/CMS listening tours that drew nearly 100,000 participants and submission of about 4,000 stakeholder comments on the proposed rule.

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