Medicare Reimbursements Shift towards Quality of Care

In an open letter last Friday, October 14, the Centers for Medicare and Medicaid Services (CMS), announced the finalized policies for implementing the new Medicare Quality Payment Program (QPP). Although the rule takes effect on January 1, 2017, several components will be phased in over the next few years to give physicians time to adjust accordingly. Many of the policies have been updated from the previous proposal in response to feedback from clinicians across the country.

The QPP, a component of the bipartisan Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), continues the CMS’s transformation from fee-for-service reimbursements to payment systems geared towards high-quality, cost-efficient care. In this final rule, the basic proposed structure of the QPP remains unchanged from preceding propositions, but the timeline for implementation has been extended so that clinicians can choose their own pace in adapting to the new requirements.

Priorities of the new system:

• Focusing on the patient – The QPP reduces the amount of required reporting and paperwork, instead allowing practices more time to spend with patients and the flexibility to use the metrics that best represent their patients’ needs.
• Implementing features gradually – When the program becomes effective next year, the Merit-Based Incentive Payment System (MIPS) will not change much from the current structure; 2017 and 2018 are viewed as transition years that permit clinicians to learn the new system without penalty, if so desired. Clinicians who thoroughly embrace the new program may earn a higher bonus based on their performance, but they also risk a larger payment reduction.
• Adding new ways to participate in Advanced Alternative Payment Models (APMs) – CMS will gradually expand the opportunities for taking part in Advanced APMs, thus offering a wider range of options to better match the various practices and care throughout the nation.
• Relaxing requirements for small and rural practices – These groups will be subject to less onerous standards to ease the adjustment to the new program and to encourage higher bonuses and rates of participation.
• Aligning quality metrics with practice-specific improvement activities – Certified electronic health records (EHR) technology will be expected to support high-quality care and to make reporting easier for clinicians.

As the healthcare industry continues to adopt a more high-quality, yet cost-conscious, standard of care, technologies such as telemedicine will become an integral tool in a physician’s arsenal. The ability to deliver care to patients in a more accessible setting will lower costs while maintaining a high standard of care—which is exactly what the CMS wants to see.

To read the open letter from CMS detailing the final rule, visit the CMS blog here.

To view a demo of swyMed live video medicine platform, click here.