Patients are the stated reason for Medicare’s Quality Payment Program, but a new payment formula is not a treatment result. In its rule published November 4, 2016, CMS established incentives through the Merit-based Incentive Payment System, or MIPS, and Advanced Alternative Payment Models. This November 12 retrospective concerns that earlier decision. [2016-25240][2016-10032]

The May 9 proposal explains the administrative starting point: combining components of three existing programs, with standards across four performance categories. It also contemplated separate scoring for clinicians in certain alternative payment models. That history explains the ambition to reduce overlapping administration; it does not establish that staff or patients actually saved time. [2016-25240][2016-10032]

The final rule, effective January 1, 2017, made 2017 a transition performance year for 2019 payment adjustments. Eligible clinicians could choose different reporting paces. The low-volume exclusion covers clinicians with no more than $30,000 in Medicare Part B allowed charges or no more than 100 Medicare patients; meeting either limit matters. [2016-25240][2016-10032]

These accommodations make the patient question more specific: can practices build reporting capacity while keeping care at the center? CMS describes that as its purpose, not an observed outcome. The proposal and final rule belong to one policy process, not two independent evaluations. Their strongest evidence concerns program design; judging better treatment requires evidence beyond these documents. [2016-25240][2016-10032]

Source documents

  1. 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 Modelshttps://www.govinfo.gov/content/pkg/FR-2016-11-04/html/2016-25240.htm
  2. 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 Modelshttps://www.govinfo.gov/content/pkg/FR-2016-05-09/html/2016-10032.htm