ASCRS Medicare Physician Payment Reform Resource Center

VIEW THE QUALITY PAYMENT PROGRAM PROPOSED RULE GUIDE HERE

 

 

ASCRS•ASOA played a leading role in the medical community's efforts to repeal and replace the flawed Sustainable Growth Rate (SGR) formula and is now offering its members resources to assist in understanding the new law and the new Merit-Based Incentive Payment System (MIPS). 

H.R. 2, the Medicare Access and CHIP Reauthorization Act of 2015, passed the House of Representatives on March 26, 2015 by an overwhelming bipartisan vote of 392-37 and passed the Senate on April 14 with a similarly wide margin of 92-8. President Obama signed the bill into law (PL 114-10) on April 16, 2015.

Beginning July 1, 2015, the fee schedule conversion factor was increased by 0.5% and will be by another 0.5% on January 1, 2016.

Specifically, H.R. 2:

  • Repeals the SGR and replaces it with 5 years of 0.5% positive updates to Medicare physician reimbursement;
  • Preserves a fee-for-service option;
  • Consolidates current quality reporting programs—PQRS, EHR Meaningful Use, and the Value-Based Payment Modifier—into a new program, the Merit-Based Incentive Payment System (MIPS) in 2019;
  • Penalties associated with the current quality programs are sun-set after 2018;
  • Through the MIPS program, physicians will receive a composite score, which will be compared with benchmarks to determine whether they receive a bonus, a penalty, or no payment adjustment. Additional bonus funds will be available for exceptional performance;
  • Physicians receiving a majority of their payments through an alternative payment method, such as an ACO or medical home, will be exempt from MIPS; and
  • Prevents CMS from proceeding with its policy to transition all 10- and 90-day global codes to 0-day.

The Next Steps

ASCRS•ASOA members are encouraged to familiarize yourself with the documents provided below that summarize the new law and outline the MIPS program. Additional details associated with the MIPS program will be determined in the coming years through the rulemaking process. We will continue to monitor these issues and will provide updates to members when they are available. We will continue to submit comments on CMS rulemaking and work to advocate on behalf of our members to ensure the programs do not inflict undue regulatory requirements. 

We will continue to update this webpage with information as it becomes available. As always, ASCRS•ASOA Government Relations staff is available to assist you or answer questions at any time at 703-591-2220.