September 8, 2016
By Andy Slavitt, Acting Administrator of CMS
By Andy Slavitt, Acting Administrator of CMS
“Plans for the
Quality Payment Program in 2017: Pick Your Pace"
As the baby boom generation ages, 10,000 people enter the
Medicare program each day. Facing that demand, it is essential that Medicare
continues to support physicians in delivering high-quality patient care. This
includes increasing its focus on patient outcomes and reducing the obstacles
that make it harder for physicians to practice good care.
The bipartisan Medicare Access and CHIP Reauthorization Act of
2015 (MACRA) offers the opportunity to advance these goals and put Medicare on
surer footing. Among other policies, it repeals the Sustainable Growth Rate
formula and its annual payment cliffs, streamlines the existing patchwork of
Medicare reporting programs, and provides opportunities for physicians and
other clinicians to earn more by focusing on quality patient care. We are
referring to these provisions of MACRA collectively as the Quality Payment
Program.
We received feedback on our April proposal for implementing the
Quality Payment Program, both in writing and as we talked to thousands of physicians
and other clinicians across the country. Universally, the clinician community
wants a system that begins and ends with what's right for the patient. We heard
from physicians and other clinicians on how technology can help with
patient care and how excessive reporting can distract from patient care; how
new programs like medical homes can be encouraged; and the unique issues facing
small and rural non-hospital-based physicians. We will address these areas
and the many other comments we received when we release the final rule by
November 1, 2016.
But, with the Quality Payment Program set to begin on January 1,
2017, we wanted to share our plans for the timing of reporting for the first
year of the program. In recognition of the wide diversity of physician
practices, we intend for the Quality Payment Program to allow physicians to
pick their pace of participation for the first performance period that begins
January 1, 2017. During 2017, eligible physicians and other clinicians
will have multiple options for participation. Choosing one of these options
would ensure you do not receive a negative payment adjustment in 2019. These
options and other supporting details will be described fully in the final rule.
First Option: Test the Quality Payment Program.
With this option, as long as you submit some data to the Quality
Payment Program, including data from after January 1, 2017, you will avoid a
negative payment adjustment. This first option is designed to ensure that your
system is working and that you are prepared for broader participation in 2018
and 2019 as you learn more.
Second Option: Participate for part of the calendar year.
You may choose to submit Quality Payment Program information for
a reduced number of days. This means your first performance period could begin
later than January 1, 2017 and your practice could still qualify for a small
positive payment adjustment. For example, if you submit information for part of
the calendar year for quality measures, how your practice uses technology, and
what improvement activities your practice is undertaking, you could qualify for
a small positive payment adjustment. You could select from the list of quality
measures and improvement activities available under the Quality Payment
Program.
Third Option: Participate for the full calendar year.
For practices that are ready to go on January 1, 2017, you may
choose to submit Quality Payment Program information for a full calendar year.
This means your first performance period would begin on January 1, 2017. For
example, if you submit information for the entire year on quality measures, how
your practice uses technology, and what improvement activities your practice is
undertaking, you could qualify for a modest positive payment adjustment. We've
seen physician practices of all sizes successfully submit a full year’s quality
data, and expect many will be ready to do so.
Fourth Option: Participate in an Advanced Alternative Payment
Model in 2017.
Instead of reporting quality data and other information, the law
allows you to participate in the Quality Payment Program by joining an Advanced
Alternative Payment Model, such as Medicare Shared Savings Track 2 or 3 in
2017. If you receive enough of your Medicare payments or see enough of your
Medicare patients through the Advanced Alternative Payment Model in 2017, then
you would qualify for a 5 percent incentive payment in 2019.
However, you choose to participate in 2017, we will have
resources available to assist you and walk you through what needs to be done.
And however you choose to participate, your feedback will be invaluable to
building this program for the long term to achieve outcomes that matter to your
patients.
We appreciate the sincere and constructive participation in the
feedback process to date and look forward to advancing step-by-step in that
same spirit. We look forward to releasing the final details about the
program this fall. Most importantly, we look forward to further engagement with
physicians and other clinicians toward our shared goal of the highest quality
of care and best outcomes for patients.
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