CMS Releases Details of New Medicare Physician Payment System
Share |

On April 27, the Centers for Medicare and Medicaid Services (CMS) released the much-anticipated proposed regulations that will govern implementation of the new Medicare physician payment system that replaces the sustainable growth rate formula repealed by Congress one year ago.

The new system offers physicians two pathways for Medicare payment beginning in 2019: The Merit-Based Incentive Payment System (MIPS) or participation in an alternative payment model (APM).

CMS proposed rule details how current CMS initiatives, including the Physician Quality Reporting System, the physician value-modifier, and electronic health record (EHR) meaningful use, will be streamlined and incorporated in the MIPS.

The rule also establishes incentives for participation in certain APMs and includes proposed criteria for use by the Physician-Focused Payment Model Technical Advisory Committee in making comments and recommendations on physician-focused payment models (PFPMs).

Even though the financial effects of the new physician payment system will not be felt until 2019, as with past CMS reporting programs, MIPS scores will be based upon the care a physician, or other eligible clinician, delivers in 2017 (January 1 December 31). 

Proposed Rule Highlights


  • The rule proposes measures, activities, reporting, and data submission standards across four performance categories: (1) quality; (2) resource use; (3) clinical practice improvement activities (CPIAs); and (4) advancing care information (previously referred to as EHR meaningful use).

  • MIPS eligible clinicians have the flexibility to submit information individually or via a group.

  • Proposed scoring methodology eliminates the need for an all or nothing scoring as has been the case under some other CMS programs.

  • Physicians and other eligible clinicians would need to report a minimum of six quality measures.

  • Resource use measures would be similar to those used under the current physician value-based modifier program.

  • There would be no minimum requirement for reporting CPIAs.


  • CMS proposes two types of Advanced APMs: Advanced APMs and Other Payer Advanced APMs.

  • CMS proposes a definition for PFPMs and criteria that would be used to evaluate proposals for PFPMs.

The Urgent Care Association of America (UCAOA) will undertake a thorough review and analysis of the proposed rule. UCAOA will make additional information and resources available to UCAOA members so they can adequately prepare for this major Medicare payment transition.

CMS is accepting public comment on its proposals until June 27, 2016. Final regulations will be released later this year.

Membership Management Software Powered by YourMembership  ::  Legal