In response to clinician feedback, CMS has outlined a more gradual payment transformation intended to evolve over years to come. Physicians and major medical groups are responding with guarded optimism.

In the months leading up to the final rule, clinicians and healthcare organizations spoke out forcefully about their concerns about MACRA. With the release of its 2,398-page final rule on Friday, Centers for Medicare & Medicaid Services (CMS) officials appear to have heard them.

The feedback CMS received through scores of written and face-to-face comments can be summed up as a plea to make clinicians' and practices' transition to its new payment system as simple and flexible as possible, Acting Administrator Andy Slavitt said during a press briefing Friday.

Learn More about the New Medicare Quality Payment Program – Upcoming Webinars

The Centers for Medicare & Medicaid Services (CMS) invites you to join a webinar on October 26 at 2:00 PM ET, on the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA) final rule with comment period. The webinar will provide an overview of the Merit-based Incentive Payment System (MIPS) andAdvanced Alternative Payment Model (APM) incentive payment provisions under MACRA, collectively referred to as the Quality Payment Program.

Webinar Details

Quality Payment Program Overview

  • Date: Wednesday, October 26, 2016
  • Time: 2:00 to 3:00 PM ET
  • Register:

Space for this webinar is limited. Register now to secure your spot. After you register, you will receive an email message with a dial-in number and webinar link. Please note, you will not be able to share your participant information because it will be unique to you.

Quality Payment Program Final Rule MLN Connects® Call — November 15

  • Date: Tuesday, November 15, 2016
  • Time: 1:30 to 3:00 PM ET
  • Register:MLN Connects Event Registration
  • Target Audience: Medicare Part B Fee-For-Service clinicians, office managers and administrators; state and national associations that represent healthcare providers; and other stakeholders.

Space may be limited, register early.During this call, learn about the provisions in the recently released final rule; participants should review the rule prior to the call.A question and answer session will follow the presentation.

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Overview of the skilled nursing facility value-based purchasing program

This article is intended for physicians, clinical staff, and

administrators of skilled nursing facilities (SNFs) submitting

claims under the SNF prospective payment system (PPS)

to Medicare administrative contractors (MACs) for services

provided to Medicare beneficiaries during a SNF stay.

What you need to know

The Centers for Medicare & Medicaid Services (CMS) SNF

value-based purchasing (VBP) program is one of many

VBP programs that aims to reward quality and improve

health care. Beginning October 1, 2018, SNFs will have

an opportunity to receive incentive payments based on

performance on the specified quality measure.

Background

The Protecting Access to Medicare Act (PAMA) of 2014,

enacted into law on April 1, 2014, authorized the SNF VBP

program. PAMA requires CMS to adopt a VBP payment

adjustment for SNFs beginning October 1, 2018. By law,

the SNF VBP program is limited to a single readmission

measure at a time.

PAMA requires CMS, among other things, to:

Furnish value-based incentive payments to SNFs for

services beginning October 1, 2018.

Develop a methodology for assessing performance

scores.

Adopt performance standards on a quality measure

that include achievement and improvement.

Rank SNFs based on their performance from low to

high. The highest ranked facilities will receive the highest

payments, and the lowest ranked 40 percent of facilities

will receive payments that are less than what they

otherwise would have received without the program.

CMS will withhold 2 percent of SNF Medicare payments

starting October 1, 2018, to fund the incentive payment

pool and will then redistribute 50-70 percent of the withheld

payments back to SNFs through the SNF VBP program.

Readmissions Measures

Skilled Nursing Facility 30-Day All Cause Readmission

Measure (SNFRM)

In the

Fiscal Year (FY) 2016 SNF Prospective Payment

System (PPS) final rule

, CMS adopted the SNFRM as the

first measure for the SNF VBP Program. The measure

is defined as the risk-standardized rate of all-cause,

unplanned hospital readmissions of Medicare beneficiaries

within 30 days of discharge from their prior hospitalization.

Hospital readmissions are identified through Medicare

hospital claims (not SNF claims) so no readmission data is

collected from SNFs and there are no additional reporting

requirements for the measure.

Performance scoring

CMS has adopted these scoring methodologies to

measure SNF performance that includes levels of

achievement and improvement:

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