The law enacted by Congress and signed by the President changes the current Medicare physician reimbursement system by:
- Permanently repealing the Medicare SGR
- Establishing an update of 0.5 percent for the remainder of 2015
- Establishing an annual update of 0.5 percent for years 2016-2019
- Allowing physicians who enroll in CMS approved Alternative Payment Models (APMs) to receive a bonuses of plus 5 percent for years 2019-2024
- For years 2026 and beyond, establishing an update of 0.75 percent for providers in APMs and an update of 0.25 percent for providers who remain in the traditional Medicare fee for service payment system
- For all years, participation in APMs is voluntary and the Medicare traditional fee for service system will continue
- Providing smaller practices technical support (funded at $20 million annually) to assist in APM participation
- Providing funding to develop physician quality measures (funded at $15 million for 2015-2019)
The law also makes some important changes to Medicare’s existing quality reporting programs. Starting 2018, Medicare’s three existing quality reporting programs, Physician Quality Reporting System (PQRS) electronic health record/meaningful use (MU) and Value-based payment modifier (VBM) are consolidated into one program called Merit-Based Incentive Payment System (MIPS). Physicians who score well under the new MIPS system will be eligible for 4 to 9 percent bonus payments. MIPS also improves upon current quality incentives programs in that it eliminates the requirement that there be winners who get bonuses, and losers, who get penalties (as currently required in the VBM system). MIPS also allows “sliding scale” bonus payments for providers that partially meet performance standards – eliminating the “all or nothing” aspect of both MU and PQRS systems.
The law requires CMS to establish and reimburse at least one code for monthly chronic care management. The law also includes a provision that prevents quality standards and measures from being used as standard practice or duty of care standards in malpractice cases.
