CMS Details MACRA Quality Reporting, Payment Reform Proposals

In the first update to the Medicare physician fee schedule (PFS) since the sustainable growth rate (SGR) formula was repealed in April, CMS has unveiled its proposed rule for implementing some of its major changes to the industry’s clinical quality reporting and value-based reimbursement frameworks. 

The updates, slated to take effect at the beginning of 2016, include modifications to the Physician Quality Reporting System (PQRS), EHR Incentive Programs, and Physician Value-Based Payment Modifier, among other things.

“CMS is building on the important work of Congress to shift the Medicare program toward a system that rewards physicians for providing high quality care,” said Andy Slavitt, Administrator of CMS in a press release.  “Thanks to the recent landmark Medicare and children’s health insurance program legislation, CMS and Congress are working together to achieve a better Medicare payment system for physicians and the American people.”  

The proposed rule, which closely follows provisions previously laid out in the Medicare Access and CHIP Reauthorization Act (MACRA), includes the following notable changes, updates, and adjustments:

Quality data reporting and payment through PQRS and the EHR Incentive Program

The Physician Quality Reporting System (PQRS) program is coming to an end in 2018 as it completes its transition into the new Merit-Based Incentive Payment System (MIPS).  Negative payment adjustments of up to 2 percent will apply in 2018 to providers who do not satisfactorily report or participate in the program in 2016.