Eli's Rehab Report

Published on Tue May 26, 2015 PDF

Not surprisingly, the MACRA legislation adds fuel to quality-based reimbursement fire, after eliminating the SGR. Quality reporting programs, such as the Physician Quality Reporting System, Value-Based Modifier, and Electronic Health Records Meaningful Use program, are on the rise, and MACRA aims to consolidate some of these programs under one umbrella, the Merit-Based Incentive Payment System (MIPS). MIPS eligible professionals will receive a composite MIPS score based on the following performance categories:

• Quality

• Resource use

• Clinical practice improvement activities

• Meaningful use of certified EHR technology

The MIPS program “does sunset most existing quality incentive programs for outpatient services, but other quality initiatives like the IMPACT Act requirements continue — but those are more facility level efforts,” clarifies Tim Nanof, director of health care policy and advocacy for the American Speech-Language Hearing Association. “MIPS would be all services previously paid on the fee schedule for MIPS eligible providers.”

Don’t, however, expect anything soon. MIPS is a general idea that needs lots of details ironed out by CMS before it becomes a working system, and it’s not slated to affect your payments until 2019. For now, keep on doing what you must to participate in each applicable quality program to avoid penalties.

“We will be looking to the 2016 Medicare Physician Fee Schedule proposed rule for any changes in the next year,” Nanof says.

Extra: Some providers can qualify for a payment incentive simply for participating in alternative payment models (APMs). 

What exactly is an APM? “We view alternative payment models as any service delivery and payment model not based on fee for service,” Nanof says. “The new metrics of quality influencing payment is a piece but not sufficient to qualify as an APM. We envision episodic payment system and shared risk models based on outcomes to be the foundation for most APMs.”