OIG: CMS hasn’t built MACRA IT infrastructure

While the final rule implementing the Medicare Access and CHIP Reauthorization Act (MACRA) will allow practices to submit only some data in 2017, CMS doesn’t have the IT infrastructure in place to collect it.

According to a report from HHS’s Office of the Inspector General (OIG), CMS has focused its IT resources on “ensuring the public-facing website” was complete when the final rule on the MACRA’s Quality Payment Program (QPP) was released, and is currently working on the QPP service desk.

What’s on the IT to-do list includes building the infrastructure to receive physician-submitted data, allow practice to figure out their scores in Merit-based Incentive Payment System (MIPS), provide physician feedback and adjust payments. The OIG report considered this a vulnerability due to the agency’s checkered past with IT projects.

“Building and testing the extensive IT systems necessary to support critical QPP operations will require significant and sustained effort over the forthcoming year,” the report said. “In the past, CMS has sometimes experienced delays and complications related to major IT initiatives, such as those required for the continued operation of Medicare Part D and HealthCare.gov. If the complex systems underlying the QPP are not operational on schedule, the program will struggle to meet its goal of improving value and quality.”

The agency’s backup plan is to use existing data submission systems for other programs like the Physician Quality Reporting System (PQRS). The use of 2017 as a transition year also granted CMS extra flexibility in building these backend IT systems.

These technology issues aren’t anything new, according to former National Coordinator for Health IT Farzad Mostashari. He tweeted that “inflexible” IT infrastructure at CMS, written in an older programming language, has limited the agency’s ability to implement policies.

“We wanted to, but couldn't, create a nationwide directory of direct addresses, as a by-product of the (meaningful use) attestation process in 2013,” he tweeted as one example.

The lack of outreach on these IT limitations for QPP could be an issue, according to the OIG report. Awareness of the new payment tracks had already been low among physicians before the final rule was released.