CMS Pro­poses Qual­ity Pay­ment Pro­gram Rule

Health Data Management - - WASHINGTON REPORT - —G.S.

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.

In Oc­to­ber 2016, CMS pub­lished a fi­nal rule to im­ple­ment the Qual­ity Pay­ment Pro­gram (QPP) un­der the Medi­care Ac­cess and CHIP Reau­tho­riza­tion Act (MACRA), de­signed to re­ward providers for value and im­proved health out­comes. As part of the pro­gram, clin­i­cians have two tracks from which to choose—the Merit-Based In­cen­tive Pay­ment Sys­tem (MIPS) or the Ad­vanced Al­ter­nate Pay­ment Models (APMs), based on prac­tice size, spe­cialty, lo­ca­tion or pa­tient pop­u­la­tion.

The new ap­proach in MACRA in­cor­po­rates pay­ments to re­ward providers for their use of IT 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,” the agency an­nounce­ment noted.

If fi­nal­ized, the pro­posed rule would ad­vance CMS’ goals of reg­u­la­tory re­lief, pro­gram sim­pli­fi­ca­tion, and state and lo­cal flex­i­bil­ity in cre­at­ing in­no­va­tive ap­proaches to health­care de­liv­ery.

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 will be re­duced.

As for health IT, CMS pro­poses re­duced bur­dens and in­creased 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.

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