The move away from fee-for-service toward value-based medical care took a major step when the Centers for Medicare and Medicaid Services put forward its new proposed rule in late April.

In a commentary about the proposal in a recent JAMA issue, Dr. Jeffrey Clough of the Duke Clinical Research Institute and Dr. Mark McClellan, director of the Duke-Margolis Center for Health Policy, urged physicians to understand the changes — and opportunities — arising from the new payment scheme in the Medicare Access and CHIP Reauthorization Act (MACRA).

“Our aim in this commentary is to provide physicians with an overview of the options for participation in payment reform and quality improvement under MACRA. Their leadership is essential to the future of high-value health care,” Clough told Duke Today.

This new proposal from CMS has was officially published in early May in the Federal Register and is entitled "Medicare Program; Merit-Based Incentive Payment System (MIPS) and Alternative Payment Model (APM) Incentive Under the Physician Fee Schedule, and Criteria for Physician-Focused Payment Models."

Although the new proposal takes on the "historic and complex" task of changing the way health care billing is done, the Duke authors advise that it still needs vital input. "The rule leaves many questions unsettled, including certainty about the best pathways forward for many types of physicians, and how much influence the reforms will have on quality of care and spending for Medicare beneficiaries," they noted in their JAMA commentary.

The bottom line of the changes is summed up in the four Components of the Composite Performance Score of the Merit-Based Incentive Payment System

Quality (50% Decreasing to 30% in 2021)
• Physicians must report on at least 6 quality measures, including 1 outcome measure if available, from an annually updated inventory (example outcome measures include functional improvement following surgery and depression remission).

Resource Use (10% Increasing to 30% in 2021)
• These measures will be calculated by CMS using claims, including 2 general measures that assess the total cost of care for beneficiaries during a year or surrounding a hospitalization, as well as 40 clinical episode measures, as a basis for rewarding efficient physicians.

Advancing Care Information (25%)
• This category replaces meaningful use measures on health information technology with fewer and more flexible reporting requirements intended to promote interoperability and data flow relevant to a physician’s practice, rather than electronic health record capabilities per se.

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