Monday, September 28, 2015

CMS Issues Request for Comment on New Physician Payment Incentives

Last spring, the SGR reform bill ("MACRA") included sections allowing CMS to create new, and considerably larger, penalties and incentives for physician behavior.   The new incentive systems include one system that consolidates and expands existing fragmented incentives (such as e-Prescribing, PQRS, and electronic health records) into a program called MIPS.   The other system is for doctors active in ACOs and is called APM.

Two articles on the topic appeared recently in the New England Journal (here, here).  MIPS stands for Merit-based Incentive Payment System.  APM, for ACO docs, stands for Alternative Payment Model.  For quick overviews of MIPS and APM, see here and here.  ACOG has a very detailed review, here.

On September 28, 2015, CMS released a lengthy blog on the Health Affairs website along with a formal Request for Information on how it should implement MACRA, MIPS, and APM over the next several years.

The CMS Chief Medical Officer's blog at Health Affairs is here.

The 42-page formal request for information, which has a 30 day clock, is here.

In summer physician fee rulemaking, CMS also requested preliminary comment on MIPS and APM, while flagging that the just-released RFI would eventually follow.  A number of organizations put their summer rulemaking comments on line in recent weeks (e.g. here).