CMS releases final Quality Payment Program rule

At the agencies

The Centers for Medicare and Medicaid Services (CMS) recently released the final rule for the Quality Payment Program (QPP) and the 2018 physician fee schedule rule. The most substantive shift from the proposed June rule was that the resource use will form 10 percent of eligible physicians' scores for the Merit-based Incentive Payment System (MIPS) in 2018. Quality performance will determine 50 percent of the score, Advancing Care Information (ACI) will make up 25 percent and the final 15 percent will be based on clinical practice improvement activities. Moreover, the reporting period for performance on cost and quality will be extended to a full year, up from 90 days this year. The rule also reweights the ACI performance category to 0 percent for clinicians in ambulatory surgical centers and hospitals, those who have a "significant hardship" and those adversely affected by Hurricanes Harvey, Irma and/or Maria. The rule will be open for comments for an unspecified amount of time.

CMS recently released a notice announcing the final federal share Disproportionate Share Hospital (DSH) allotments for federal fiscal year (FY) 2015 and the preliminary federal share DSH allotments for FY 2017. This notice also provides information on the calculation of such FY DSH allotments, the calculation of the states' institutions for mental diseases (IMDs) DSH limits and the amounts of states' final FY 2015 IMD DSH limits and preliminary FY 2017 IMD DSH limits. CMS will publish states' final FY 2017 DSH allotments in a future notice based on the states' four quarterly Medicaid expenditure reports for FY 2017 available following the end of FY 2017.

CMS Administrator Seema Verma said that CMS is revising quality measures across all programs as part of its Meaningful Measures initiative. According to Administrator Verma, the agency will move towards measuring outcome rather than process and will streamline measures. CMS did not, however, update the overall Hospital Quality Star Rating because it is still evaluating the program’s methodology. Administrator Verma said the changes will result in higher impact quality measures to safeguard public health and more focused, outcome-based measures. The agency will focus public health-related measures on prevention and treatment for opioid addiction. Administrator Verma said the agency has been and will continue to look at the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) in order to craft an approach that will minimize the burden on healthcare providers.

Over half of the accountable care organizations (ACOs) that participated in the Medicare Shared Savings Program reduced Medicare spending, and almost all of them scored 94 percent or higher on quality care, according to results released by CMS. Thirty-one percent of ACOs in the Shared Savings Program earned bonuses, and 25 percent saved money but not enough to earn a percentage as bonuses. ACOs in the Medicare Shared Savings Program and in three other demonstrations saved a collective $70.6 million in 2016. The three additional demonstrations have fewer participants and are aimed at testing approaches not allowed in the other demonstrations. Physician-only ACOs fared better than those including hospitals, with 41 percent of the former earning bonuses and only 23 percent of the latter. On the 25 measures used, average performance increased 15 percent. The average quality score for pay-for-performance ACOs was 95 percent, and 98 pay-for-reporting ACOs earned a score of 100 percent.

The Department of Health and Human Services (HHS) released an analysis showing a significant rise in rates for health plans sold on exchanges for the 2018 plan year, causing an increase in premium subsidies for silver plans. The average monthly federal subsidy will increase to $555 next year, up from $382 this year. Insurers are raising premiums to compensate for the loss of cost-sharing reduction (CSR) payments. The rate increases will largely impact the silver plans that otherwise would qualify for CSR payments in order to reduce the impact for customers who do not qualify for federal subsidies. Customers will also be faced with fewer choices on the exchange market: almost one-third of customers will only have one option of insurer, and in eight states there will be only one option in every county.

On the Hill

The House of Representatives passed a bill to extend the Children’s Health Insurance Program (CHIP) funding for five years and funding for community health centers for two years. It also extends funding for the Special Diabetes Program, Family-to-Family Health Information Centers, the Youth Empowerment Program and the Personal Responsibility Education Program (PREP). It includes $1 billion for Puerto Rico’s Medicaid program and delays DSH program cuts for two years. Democrats oppose the bill’s offsets, including taking $6.3 billion from the Prevention and Public Health Fund. The bill would also shorten grace periods to repay missed premiums for those who receive Obamacare subsidies, which the Congressional Budget Office says could result in nearly 700,000 people losing coverage. Other provisions of the bill would make wealthier Medicare beneficiaries pay more for Part B and Part D premiums, other sources of health insurance pay claims before Medicaid and lottery winnings be counted when determining Medicaid eligibility.

The House voted to repeal the ACA’s Independent Payment Advisory Board (IPAB), an unelected board meant to slow the growth of Medicare spending, with the support of all Republicans and 76 Democrats. Medicare spending had not risen to a level for the board to go into effect, but it faced opposition from both Democrats and Republicans. Two Senate bills have been introduced to repeal IPAB, one by Senate Majority Whip John Cornyn (R-TX) and one by Sen. Ron Wyden (D-OR), but votes on either bill have yet to be scheduled. The repeal effort has been praised by healthcare associations and other stakeholders.

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