Avalere’s Take on the Quality Payment Program Proposed Rule

Summary

Today, the Centers for Medicare & Medicaid Services (CMS) released the proposed rule that makes changes to the Quality Payment Program (QPP) for 2018, the second year of the program created by the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA).

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The proposed rule implements changes to the two pathways for clinicians participating in Medicare Fee-for-Service: (1) the Merit-Based Incentive Payment System (MIPS) and (2) Advanced Alternative Payment Models (Advanced APMs).

The QPP proposed rule addresses:

The continuation or modification of the “pick your pace” options under MIPS
Changes to the MIPS performance category weighting and reporting requirements
Advanced APM qualification requirements and the calculation of “nominal” financial risk
Other payer Advanced APMs
Projections of winners and losers under MIPS and the number of clinicians participating in Advanced APMs
Changes to the regulatory requirements governing PTAC (the Physician-Focused Payment Model Technical Advisory Committee)

MACRA passed Congress in 2015 with 90 percent support, including from then-Representative and current HHS Secretary Tom Price. Changes to the QPP for 2018 will indicate how Price plans to increase flexibility for providers and accelerate the movement toward value-based payment and delivery systems.

“While payment reform remains a bipartisan issue, we expect that this administration will continue to push for policies that support flexibility and choice for physicians,” said John Feore, director at Avalere Health. “Today’s proposed rule signals Secretary Price’s continued commitment to the shift to value and expanding payment options for providers.”