Medicare Payment Reform

On January 1, 2017, the final rule to implement MACRA’s Quality Payment Program (QPP) will take effect, ushering in one of the biggest changes in the program’s 51-year history. The law, which passed by large bipartisan margins in the House and Senate and was signed by President Obama in April 2015, will move physicians and other eligible Part B providers into a value-based payment system. The long-awaited final rule will govern both the Merit-Based Incentive Payment System (MIPS) and the Advanced Alternative Payment Model (APM) incentive payment program, which collectively constitute the QPP.

MACRA doesn’t affect Medicare payments to Part B providers until 2019, but 2017 is the first performance year that will be used to determine those 2019 payments. The final rule modified the low-volume threshold, excluding small practices from reporting requirements in 2017 if they record less than or equal to $30,000 in Medicare Part B-allowed charges or have less than 100 Medicare patients. For everyone else, the rubber will hit the road in 2017. Pick your pathway — MIPS or APM — and then pick your pace.