MACRA proposed rule brings new decisions

Bob GattyWashington-Urologists and other physicians who serve Medicare patients face some new decisions now that the Centers for Medicare & Medicaid Services (CMS) has proposed new regulations implementing last year’s fee schedule reform law, while also replacing the existing meaningful use program with a more flexible approach to technology and electronic health records.

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“We have more work to do, but we are committed to implementing this important legislation and creating a health care system that works better for doctors, patients, and taxpayers alike,” said Health and Human Services Secretary Sylvia M. Burwell, referring to the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA), which reforms the Medicare physician payment system and ends the troubling pay cut crises that occurred year after year.

“We look forward to listening and learning from the public on our proposal for how to advance that goal,” Burwell said.

Rule streamlines payment programs

The proposed rule, issued April 27, streamlines a patchwork of programs that are designed to measure the value and quality of care provided by doctors and other clinicians. Some physicians participate in alternative payment models (APMs) such as accountable care organizations, the Comprehensive Primary Care Initiative, and the Medicare Shared Savings Program, and most participate in such programs as the Physician Quality Reporting System, the Value-Based Payment Modifier Program, and the Medicare Electronic Health Record Incentive Program.

MACRA streamlined these programs into a single framework to help physicians transition from volume-based payments to those based on value. The new rule implements those changes by establishing the Quality Payment Program, giving physicians two options for Medicare reimbursement. They can participate either in the merit-based incentive payment system (MIPS) or Advanced APMs.

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“We are working with the medical community to advance our collective vision for Medicare payment reform,” said Patrick Conway, MD, MSc, acting principal deputy administrator and chief medical officer at CMS. “By proposing a flexible, rather than a one-size-fits-all program, we are attempting to reflect how doctors and other clinicians deliver care and give them the opportunity to participate in a way that is best for them, their practice, and their patients.”

Next - CMS: Most Medicare clinicians will initially participate through MIPS

In its announcement of the rule, CMS said most Medicare clinicians will initially participate through MIPS. The agency said the proposed rule would increase clinician flexibility by allowing them to choose measures and activities appropriate to the type of care they provide. MIPS provides for payment through these performance categories: Quality, Advancing Care Information, Clinical Practice Improvement Activities, and Cost.

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Those categories break down as follows:

Quality (50% of total score in year 1). Clinicians would choose to report six measures from a range of options that accommodate differences among specialties and practices.

Advancing Care Information (25% of total score in year 1). Clinicians would choose to report customizable measures that reflect how they use technology in their day-to-day practice, with emphasis on interoperability and information exchange.

Clinical Practice Improvement Activities (15% of total score in year 1). This category rewards clinical practice improvements, such as care coordination, beneficiary engagement, and patient safety. Clinicians may select activities that match their practices’ goals from a list of more than 90 options.

Cost (10% of total score in year 1). The score would be based on Medicare claims, so there would be no reporting requirements for clinicians. The category would use 40 episode-specific measures to account for differences among specialties.

Next: Meaningful use replacement 'simpler'

Meaningful use replacement ‘simpler’

CMS’s action to replace the meaningful use program was based on comments from more than 6,000 physicians and patients about their experience with health information technology, according to Andy Slavitt, acting administrator at CMS.

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“Our goal with Advancing Care Information is to support the vision of a simpler, more connected, less burdensome technology,” said Slavitt. “Compared to the existing Medicare Meaningful Use program for physicians, the new approach increases flexibility, reduces burden, and improves patient outcomes.”

This would occur because the new regulation would:

• allow physicians and other clinicians to choose to select the measures that reflect how technology best suits their day-to-day practice

• simplify the process for achievement and provide multiple paths for success

• align with the Office of the National Coordinator for Health Information Technology’s 2015 Edition Health IT Certification Criteria

• emphasize interoperability, information exchange, and security measures and require that patients have online access to their health information

• simplify reporting by no longer requiring all-or-nothing EHR measurement or quality reporting

• reduce the number of measures to 11 from 18, and no longer require reporting on the Clinical Decision Support and Computerized Provider Order Entry measures

• exempt certain physicians from reporting when EHR technology is less applicable to their practice and allow physicians to report as a group.

“These improvements should increase providers’ ability to use technology in ways that are more relevant to their needs and the needs of their patients,” said Slavitt.

CMS would begin measuring performance through MIPS in 2017, with payments based on those measures beginning in 2019.

Medicare physicians who participate to a sufficient extent in Advanced APMs would be exempt from MIPS reporting requirements and qualify for financial bonuses. CMS said it expects the number of clinicians who qualify as participating in Advanced APMs to grow as the program matures.

The agency is accepting comments on its proposal until June 27, 2016.

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