Should Medicare Pay Hinge on Seeing Medicaid, ACA Patients? CMS Asks

The federal government is asking physicians whether their Medicare reimbursement should hinge in part on accepting new Medicaid patients or participating in provider networks of health plans offered through Affordable Care Act (ACA) exchanges.

The question comes as the Centers for Medicare & Medicaid Services (CMS) tries to flesh out the reimbursement system Congress enacted earlier this year to replace Medicare's sustainable growth rate formula for physician pay. Yesterday, CMS issued a formal request for information (RFI) asking physicians to weigh in on how exactly the new arrangement should work.

The law that abolished the sustainable growth rate — the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) — shifts reimbursement from volume to value without entirely eliminating fee-for-service. The centerpiece of MACRA is the Merit-Based Incentive Payment System (MIPS), which will consolidate the incentive program for meaningful use of an electronic health record (EHR) system, the Physician Quality Reporting System, and the value-based modifier program. Medicare will adjust fee-for-service payments to physicians up or down, depending on how they score on various measures of clinical quality, resource use (think cost control), meaningful use of EHR technology, and clinical practice improvement activities.