Quality Payment Program Rule For 2018 Proposed By CMS


The Centers for Medicare and Medicaid Services has proposed a new rule for its Quality Payment Program in an effort to simplify reporting requirements with updates for the second and future years of the program.

The new reimbursement approach in MACRA incorporates payments to reward providers for their use of information technology and data.

“The proposed rule would amend some existing requirements and also contains new policies for doctors and clinicians participating in the Quality Payment Program that would encourage participation in either APMs or the MIPS,” according to the agency’s June 20 announcement.

“Additionally, CMS has used clinicians’ feedback to shape the second year (2018) of the program,” states the announcement. “If finalized, the proposed rule would further advance the agency’s goals of regulatory relief, program simplification, and state and local flexibility in the creation of innovative approaches to healthcare delivery. Moreover, CMS is making it easier for rural and small providers to participate.”

The agency says it is sensitive to stakeholder concerns that small, independent and rural practices, in particular, are not sufficiently prepared for the Quality Payment Program. By providing additional flexibility in its proposed rule, CMS contends that barriers would be reduced further, enhancing the ability of small practices to participate successfully.

In particular, the rule calls for an increased low-volume threshold that would exempt eligible MIPS clinicians with less than $90,000 in allowed charges or fewer than 200 Medicare Part B beneficiaries from having to participate in the program. The threshold in 2017 was $30,000 in allowed charges or fewer than 100 beneficiaries.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said CMS Administrator Seema Verma in a written statement. “That’s why we’re taking a hard look at reducing burdens.” 

When it comes to health IT, CMS proposes reduced burdens and increase flexibility to help clinicians successfully participate in QPP by continuing to allow the use of 2014 Edition Certified Electronic Health Record Technology, while encouraging the use of 2015 Edition CEHRT.

“By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on providing extended care to their patients rather than filling out paperwork,” Verma added. “CMS would continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

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