​The Department of Health and Human Services (HHS) on April 27 took the first step toward modernizing how Medicare pays physicians for quality of patient care rather than quantity. The proposed rule begins the process of implementing certain provisions of the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA). MACRA, which HHS said is supported by a bipartisan majority in Congress as well as patient groups and medical associations, should streamline the "patchwork of programs" such as Accountable Care Organizations, Medicare Shared Savings Program, Comprehensive Primary Care Initiative, the Physician Quality Reporting System, the Value Modifier Program, and the Medicare Electronic Health Record Incentive Program into a single framework called the Quality Payment Program. The Quality Payment Program will include two paths to payment, the Merit-based Incentive Payment System (MIPS) and the Advanced Alternative Payment Models (APMs). Most Medicare clinicians, HHS said, will initially participate through MIPS. MIPS will pay clinicians after calculating a score based on four clinical measures: quality (50% of the score in year 1); advancing care information (25% of score in year 1); clinical practice improvement activities (15% of score in year 1) and cost (10% of score in year 1). Clinicians who use APMs would be exempt from MIPS reporting and qualify for financial bonuses. HHS said it expects more clinicians to participate in APMs as the initiative grows.

HRC Recommends: Organizations should review the proposed rule and work to ensure that they are ready for participation; a fact sheet is available. HHS will accept comments through June 27, 2016.