CMS Proposes Changes to Quality Payment Program

Yesterday, the Centers for Medicare & Medicaid Services (CMS) issued a proposed rule to modify the Quality Payment Program. The rule would make changes to the second year of the program to make it simpler, according to a press release.

These proposed changes would be especially beneficial to small, independent, and rural practices, and would likely result in financial stability, according to the release. The CMS also reported that the changes would lead to high-quality care for Medicare patients.

“We’ve heard the concerns that too many quality programs, technology requirements, and measures get between the doctor and the patient,” said Seema Verma, CMS administrator. “That’s why we’re taking a hard look at reducing burdens. By proposing this rule, we aim to improve Medicare by helping doctors and clinicians concentrate on caring for their patients rather than filling out paperwork. CMS will continue to listen and take actionable steps towards alleviating burdens and improving health outcomes for all Americans that we serve.”

The Quality Payment Program is updated yearly under the Medicare and Access and CHIP Reauthorization Act of 2015. The initiative is designed to bring value to the healthcare system, while improving outcomes, spending wisely, minimizing regulatory burden, and increasing transparency, according to the release.

Overall, the physicians who participate in the program treat more than 57 million Medicare-insured seniors.

Currently, the program allows physicians to choose how they participate based on size, specialty, location, and patient population, the CMS noted.

The proposed rule would change certain existing regulations and contains novel policies for those participating in the Quality Payment program. The changes would encourage providers to enroll in the Advanced Alternative Payment Models or the Merit-Based Incentive Payment System.

The rule would also implement a low-volume threshold to exempt clinicians with few Medicare Part B payments or patients, according to the CMS. Additionally, it would allow flexibility for providers who are hospital-based or who have limited in-person interaction with patients.

The CMS has also taken clinician feedback into account when drafting the changes. Since the start of 2017, the agency has engaged with more than 100 organizations and more than 47,000 individuals, according to the proposal.

If finalized, the rule would increase the goals of CMS to provide regulatory relief, simplification, and flexibility in the creation of innovative approaches to healthcare delivery, according to the release.

In March, the CMS awarded $20 million to 11 organizations to ensure a successful Quality Payment Program for small practices based in underserved regions, such as rural areas, health professional shortage areas, and medically underserved areas.

The awards go to community-based organizations that will provide training to those in individual practices or those with 15 clinicians or fewer who are participating in the program. CMS plans to award an additional $80 million to support organizations over the next 4 years, demonstrating their push towards value-based care.