AANEM News Express

AANEM News Express

MACRA: CMS Releases Final Rule in Overhaul of Physician Payment Policies

On Friday, October 14, 2016, the Centers for Medicare and Medicaid Services (CMS) issued its final rule implementing key provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), the legislation passed by Congress last year replacing the flawed Sustainable Growth Rate (SGR) physician payment formula.  MACRA represents a complete overhaul of the structure of physician payments by Medicare.

The policy staff at AANEM is diligently reviewing all 2398 pages of the final rule to determine how the changes will affect AANEM members.  A cursory review indicates that CMS responded to many of the concerns expressed by the public, including the AANEM, regarding the proposed rule issued in April. 
  • Details are provided about the 2017 transition period announced in September.  The only physicians who will receive payment penalties in 2019 are those who choose to not report at all.
  • The low-volume threshold that exempts physicians from all performance reporting has been increased from $10,000 in annual Medicare revenue and less than 100 Medicare patients to $30,000 in revenue OR 100 patients.  CMS estimates that this change will exempt 32.5% of physicians and other clinicians from the program.
  • Performance reporting requirements have been reduced
  • The resource use (cost) category of the Merit-based Incentive Payment System (MIPS) has been reweighted to zero for 2017.  This category will be calculated in 2017 but will not be used to determine payment adjustment.  In 2018 use of the cost category will begin.
CMS has created a Quality Payment Program website https://qpp.cms.gov/ which provides an overview of the program and is designed to help clinicians identify potential measures.

Keep an eye on the AANEM website here for future updates and educational resources regarding the final rule on MACRA.  Please contact policy@aanem.org with any questions or concerns.

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