CMS rolls out MACRA regulation

CMS announced plans to replace its current meaningful use program for physicians participating in the Medicare program.

The new proposed rule to implement 2015’s Medicare Access and CHIP Reauthorization Act (MACRA) includes some major changes to the methods for judging physicians’ quality of care by cutting down the various quality and value measurement programs into a smaller framework.

In the 962-page rule released April 27, CMS detailed its aim to replace the current reporting systems with what its dubbed the Quality Care Program, which includes two paths: the Merit-based Incentive Payment System (MIPS) or Advanced Alternative Payment Models (APMs).

“We are working with the medical community to advance our collective vision for Medicare payment reform,” said Patrick Conway, MD, MSc, CMS acting principal deputy administrator and CMO in a statement. “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.

Most Medicare physicians would initially participate in MIPS, which links payments to four measurement criteria: quality, cost, practice improvement and technology use, which CMS has named Advancing Care Information.

In a CMS blog post, Acting Administrator Andy Slavitt and National Coordinator for Health IT Karen DeSalvo said this measurement within MIPS would both reduce the burden and increase flexibility for physicians. Clinicians would be allowed to “select the measures that reflect how technology best suits their day-to-day practice,” as well as allow physicians to report as a group or, if EHR technology is less relevant to their practice, not at all.

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

Under the proposed rule, quality would account for 50 percent of a physician’s MIPS score in the first year, Advancing Care Information would account for 25 percent, followed by 15 percent for practice improvement and 10 percent for cost.

Physicians would start being scored by MIPS in 2017, with payments becoming based on those measures in 2019.

Medicare physicians who participate “to a sufficient extent” in various alternative payment models, such as Next Generation ACOs or Comprehensive Primary Care Plus (CPC+), would be exempt from MIPS reporting requirements and qualify for financial bonuses.

Wednesday’s statement from HHS, however, appears to warn clinicians that the standards for MIPS exemption would be high.

“Many clinicians who participate to some extent in Alternative Payment Models may not meet the law’s requirements for sufficient participation in the most advanced models,” read the HHS statement. “The proposed rule is designed to provide these clinicians with financial rewards within MIPS, as well as to make it easy for clinicians to switch between the components of the Quality Payment Program based on what works best for them and their patients.”

The American Hospital Association’s statement was critical of this portion of the proposed rule, though the organization supported the larger effort to reduce the number of quality measures.

“We are disappointed by CMS’s narrow definition of alternative payment models, which could have a chilling effect on providers’ ability to experiment with new patient-centered, value-driven payment models,” said AHA Executive Vice President Tom Nickels in a statement. “Today’s rule fails to recognize the significant resources and risk assumed by the highly motivated, early adopters of alternative payment models.”

American Medical Association President Steven Stack, MD, was more supportive of the proposal.

“The rulemaking for this law also provides an opportunity to reduce the physician burden associated with the current Medicare reporting requirements for electronic health record meaningful use and clinical quality,” Stack said in a blog post. “The AMA has been vigorously pressing for needed changes to these programs. While we have not yet digested the entire 962-page regulation, it appears on our initial review that CMS Acting Administrator Andy Slavitt and his senior management team have listened.”

Public comment on the rule is open until June 26, 2016. If finalized, the rule would be implemented on January 1, 2017.