The Medicare Access and CHIP Reauthorization Act (MACRA) will significantly change reporting provider reporting requirements and introduce new payment models. The Centers for Medicare and Medicaid Services (CMS) has already made some changes and more are likely to follow. As we wait for a final rule likely to be issued this fall, here’s what some are saying about the proposed rule.
Can MACRA effectively streamline reporting?
It’s no secret that existing reporting requirements for providers are a thorn in their side. In a recent study, researchers found that providers were spending around one-half of their workdays on EHR and administrative tasks. Many of these hours are spent fulfilling quality reporting requirements.
MACRA and the CMS understand the need to reduce the burden associated with reporting requirements. In a July statement to the Senate Committee on Finance, Andy Slavitt, acting administrator at CMS, said, “Physicians and clinicians want support for a care system that focuses on quality, but too many unaligned quality programs, measures, and technology requirements can hinder their best efforts to accomplish these goals.”
The law seeks to streamline reporting requirements by combining the Physician Quality Reporting System (PQRS), the Value-Based Payment Modifier (VBM), and Meaningful Use (MU) into the Merit-Based Incentive Payment Systems (MIPS). So far, CMS has mostly been applauded for its efforts to streamline reporting, at least in intent.
“The MIPS track provides a great deal more flexibility for providers to choose measures, improvement activities and the associated use of health IT that work for them,” Arien Malec, vice president of data platform and acquisition tools at RelayHealth, told Healthcare Dive. “This level of flexibility is a marked contrast from previous similar CMS programs, like Meaningful Use and PQRS that were 'all-or-nothing.'”
Any effort to introduce simplicity to provider reporting requirements will be appreciated, Stephanie Zaremba, director of government and regulatory affairs at athenahealth, told Healthcare Dive. However, more could be done to reduce regulatory overload.
“A lot of the MIPS programs at this point are predicated on the use of EHRs and CMS is still relying on the Office of the National Coordinator for Health IT certification rules,” Zaremba said. Doing away with some or all of these requirements could allow providers more flexibility when it comes to selecting a product that is better suited to their practice, their needs, and their patients’ needs.
“It remains to be seen whether a large government bureaucracy can streamline itself to the degree needed,” Zaremba said “If they get there, that will be a big win.”
CMS addresses criticism of aggressive timelines
Payment programs established by MACRA, which was signed into law in April of this year, is set to go into effect in 2017. Since the MACRA proposed rule was issued, it was most heavily criticized for its aggressive timelines. However, CMS has responded to these concerns by introducing two pick-your-pace participation options that Malec calls “MIPS-lite” for 2017.
One MIPS option for 2017 will allow providers to participate solely in reporting while avoiding any penalties and foregoing any bonus payments. The second MIPS option will allow providers to participate for only part of the year and will deliver prorated penalties or bonus payments. These options are significant because 87% of providers were expected to be penalized in the first year of MIPS.
“They have really pulled back on what’s required next year by introducing the pick-your-pace options,” Zaremba said. “There’s a pretty low bar providers can set to avoid penalties.”
Providers aren’t paying attention
Despite the significant changes set to occur under MACRA, it seems many providers are unaware the law even exists. Only one-half of physicians surveyed had heard of MACRA, according to a July report published by Deloitte. Anecdotal evidence supports the survey results. When he asks healthcare executives about their MACRA readiness, the overwhelming response Malec receives is that they’ve “heard” of MACRA.
CMS is partly to blame, Zaremba says. Providers are accustomed to proposed changes that receive negative feedback and are then watered down or delayed. Already, CMS is essentially offering a free pass to providers this year, according to Zaremba.
Providers certainly could benefit from some clarity when it comes to preparing for MACRA. “More still needs to be done in terms of provider preparation, especially as it relates to quality measures reporting,” Malec said. “It is critical that providers have a clear grasp and roadmap for where CMS is moving provider payments so they can start adjusting their workflows and begin acquiring the tools and resources they will need.”
However tempting it may be to put off preparation until more clarity is provided, that would be a mistake. Even if the final rule on MACRA includes more watered down requirements or if certain components are delayed, there is no doubt that MACRA is coming.