- CMS released on Wednesday the proposed final rule, dubbed Advancing Care Information, that will implement the Medicare Access & CHIP Reauthorization Act of 2015 (MACRA).
- The rule lays out the establishment of the Merit-based Incentive Payment System (MIPS) which consolidates components of the Physician-Quality Reporting System, the Physician Value-based Payment Modifier, and the Medicare EHR Incentive Program for eligible professionals.
- The proposed rule is scheduled to be published in the Federal Register on May 9. The proposal will be available for public comment for 60 days.
CMS has been keeping health policy wonks busy this week. On Monday, the agency unveiled it's "uber-rule" for Medicaid managed care plans, weighing in at 1,425 pages. This afternoon, the highly-anticipated MACRA implementation proposed final rule was released to the public at a respectable 962 pages.
MACRA removes the sustainable growth rate formula, which cut Medicare payments for services, and replaced it with a .5% year-over-year increase in the physician fee schedule. The proposal links payments to value via MIPS and measures physicians in four areas:
- Technology use, and
- Practice improvement.
"This proposal, if finalized, would replace the current meaningful use program and reporting would begin January 1, 2017, along with the other components of the Quality Payment Program," wrote CMS acting Administrator Andy Slavitt and Karen DeSalvo, national coordinator at ONC, in a blog post.
In the post, the authors note the proposal attempts to move the dial for greater physician flexibility as well as reduce burden. Providers, under the proposal, can choose to get paid under MIPS or certain alternative payments models (APMs).
The rule proposed two types of alternative payment models (APM): Advanced APMs and Other-Payer Advanced APMs. Providers must meet three requirements for each model to be considered eligible.
For the two tracks of APMs, requirements include participants to use certified EHR technology and provide payment for covered professional services based on quality measures compared to those used in the quality category of MIPS.
The proposal still has a fair amount of health IT rules. "Clinicians will have to comply with a number of health IT requirements: 50 percent of clinicians must use certified EHRs by 2017, and 75 percent by 2018," Poltico PULSE's Dan Diamond noted. However, the number of EHR measures will go from 18 to 11 and clinical decision support reporting and CPOE will cease to be required.
Notably, the rule states professional services done at critical access hospitals, rural health clinics and federally qualified health centers that meet certain criteria can be counted towards the QP determination.
The rule proposes to use 2017 as the performance period for the 2019 payment adjustment. Thus, the first performance period would start in 2017 for payments adjusted in 2019. "This time frame is needed to allow data and claims to be submitted and data analysis to occur," the proposed rule stated. "In addition, it would allow for a full year of measurement and sufficient time to base adjustments on complete and accurate information."
Just last week, Subcommittee Chairman Rep. Joseph Pitts (R-PA) stated at the panel that because providers know the change is coming, they should begin preparations.
"Under the new law, Advancing Care Information would affect only Medicare payments to physician offices, not Medicare hospitals or Medicaid programs," Slavitt and DeSalvo wrote. "We are already meeting with hospitals to discuss potential opportunities to align the programs to best serve clinicians and patients, and will be engaging with Medicaid stakeholders as well."
Reactions will likely evolve as wonks get their heads above the policy tome. So far, reactions have been mixed. American Medical Assocation President Steven Stack stated, "Our initial review suggests that CMS has been listening to physicians' concerns," adding, "In particular, it appears that CMS has made significant improvements by recasting the EHR Meaningful Use program and by reducing quality reporting burdens."
The American Hospital Association's Tom Nickels had a different take on the matter. "We are deeply 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," he said. "Today's rule fails to recognize the significant resources and risk assumed by the highly motivated, early adopters of alternative payment models."
Former National Coordinator Farzad Mostashari expressed excitement over one call for public comment:
TY!— Farzad Mostashari (@Farzad_MD) April 27, 2016
"In particular, we seek comment on whether the APM benchmark or APM Entity revenue is a more appropriate basis for assessing total risk"